Provider Demographics
NPI:1134640774
Name:CRUMP, NATASHIA MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:NATASHIA
Middle Name:MARIE
Last Name:CRUMP
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:NATASHIA
Other - Middle Name:MARIE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14202 20TH AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11351-3000
Mailing Address - Country:US
Mailing Address - Phone:917-563-3350
Mailing Address - Fax:
Practice Address - Street 1:13 THOMPSON HAY PATH
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1317
Practice Address - Country:US
Practice Address - Phone:631-751-0197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker