Provider Demographics
NPI:1073771317
Name:CRAWFORD, CHARLOTTE JOANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:JOANNE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2422
Mailing Address - Country:US
Mailing Address - Phone:510-295-8377
Mailing Address - Fax:
Practice Address - Street 1:3120 TELEGRAPH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1900
Practice Address - Country:US
Practice Address - Phone:510-295-8377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 15927103G00000X, 103TC0700X, 103TC2200X, 103TF0200X, 103TP0814X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool