Provider Demographics
NPI:1225593759
Name:CRIMMINS, ERIN STEWART (LCSW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:STEWART
Last Name:CRIMMINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SEVILLE ORANGE PATH
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5403
Mailing Address - Country:US
Mailing Address - Phone:386-214-7369
Mailing Address - Fax:
Practice Address - Street 1:301 JUSTICE LN
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-4487
Practice Address - Country:US
Practice Address - Phone:386-254-1173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL160521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty