Provider Demographics
NPI:1326534991
Name:CRAWFORD, MARTHA MAULSBY (LCSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:MAULSBY
Last Name:CRAWFORD
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 1:125 COOPER AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2218
Mailing Address - Country:US
Mailing Address - Phone:917-407-5101
Mailing Address - Fax:
Practice Address - Street 1:11 HANOVER SQ FL 27
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-2835
Practice Address - Country:US
Practice Address - Phone:917-407-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-07
Last Update Date:2018-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR051133-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical