Provider Demographics
NPI:1114618782
Name:CRAWFORD, KRYSTAL BETH
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:BETH
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2527
Mailing Address - Country:US
Mailing Address - Phone:585-233-3240
Mailing Address - Fax:
Practice Address - Street 1:1175 PITTSFORD VICTOR RD STE 120
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3831
Practice Address - Country:US
Practice Address - Phone:585-351-9737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20738101YA0400X
NY18-P122246-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)