Provider Demographics
NPI:1164783825
Name:FLORES, CRAIG MATTHEW (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:MATTHEW
Last Name:FLORES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 WEST TAFT ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088
Mailing Address - Country:US
Mailing Address - Phone:315-458-6111
Mailing Address - Fax:315-458-6121
Practice Address - Street 1:5112 WEST TAFT ROAD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088
Practice Address - Country:US
Practice Address - Phone:315-458-6111
Practice Address - Fax:315-458-6121
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0837421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical