Provider Demographics
NPI:1104206945
Name:CRAYDEN, ANDREA (MSW, LISW-S)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:CRAYDEN
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W EASTON RD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:OH
Mailing Address - Zip Code:44214-9580
Mailing Address - Country:US
Mailing Address - Phone:330-466-4647
Mailing Address - Fax:
Practice Address - Street 1:733 MARKET AVE S
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-2165
Practice Address - Country:US
Practice Address - Phone:330-489-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-07
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI96491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical