Provider Demographics
NPI:1124381694
Name:CRAWFORD, CORINN MICHELLE (MA, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:CORINN
Middle Name:MICHELLE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:MS
Other - First Name:CORINN
Other - Middle Name:MICHELLE
Other - Last Name:KEENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA, LBA
Mailing Address - Street 1:48 GILMORE DR
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-1044
Mailing Address - Country:US
Mailing Address - Phone:845-641-7904
Mailing Address - Fax:
Practice Address - Street 1:48 GILMORE DR
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-1044
Practice Address - Country:US
Practice Address - Phone:845-641-7904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1119040103K00000X
NY857635174400000X
NY1901806174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist