Provider Demographics
NPI:1265648414
Name:CRAWSHAW, TIFFANY PHYLLIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:PHYLLIS
Last Name:CRAWSHAW
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3523 CROWELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4729
Mailing Address - Country:US
Mailing Address - Phone:858-336-5475
Mailing Address - Fax:
Practice Address - Street 1:3523 CROWELL ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4729
Practice Address - Country:US
Practice Address - Phone:858-336-5475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22102103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical