Provider Demographics
NPI:1174674022
Name:CRAFT, BETH NAOMI (LICSW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:NAOMI
Last Name:CRAFT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:NAOMI
Other - Last Name:LUEDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 MARJAC RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-3447
Mailing Address - Country:US
Mailing Address - Phone:617-733-1169
Mailing Address - Fax:508-337-6380
Practice Address - Street 1:354 WAVERLY ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-7079
Practice Address - Country:US
Practice Address - Phone:508-259-3169
Practice Address - Fax:508-661-0232
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10234391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P20115Medicare ID - Type Unspecified