Provider Demographics
NPI:1316224082
Name:IDASPE, CRYSTAL (LCSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:IDASPE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:MUSORRAFITI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:541 PELHAM RD
Mailing Address - Street 2:APT 7P
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-1614
Mailing Address - Country:US
Mailing Address - Phone:212-496-4060
Mailing Address - Fax:
Practice Address - Street 1:2024 WILLIAMSBRIDGE RD STE 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1631
Practice Address - Country:US
Practice Address - Phone:917-992-1569
Practice Address - Fax:917-992-1569
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077699-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical