Provider Demographics
NPI:1073792503
Name:CREWDSON-GLEIZER, NATASHA (PHD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:CREWDSON-GLEIZER
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 1:135 OCEAN PKWY APT 1P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2579
Mailing Address - Country:US
Mailing Address - Phone:347-439-2593
Mailing Address - Fax:
Practice Address - Street 1:135 OCEAN PKWY APT 1P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2579
Practice Address - Country:US
Practice Address - Phone:347-439-2593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016671-1103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent