Provider Demographics
NPI:1225065501
Name:CRAWFORD, MARY ANNE (LCPC)
Entity Type:Individual
Prefix:
First Name:MARY ANNE
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MILL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04021-3132
Mailing Address - Country:US
Mailing Address - Phone:207-829-5948
Mailing Address - Fax:
Practice Address - Street 1:222 SAINT JOHN ST
Practice Address - Street 2:SUITE 126
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3041
Practice Address - Country:US
Practice Address - Phone:207-829-5948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2313101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health