Provider Demographics
NPI:1326698325
Name:WASHBURN, KRYSTAL (LMSW)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 ASHLAND AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-2144
Mailing Address - Country:US
Mailing Address - Phone:716-939-7033
Mailing Address - Fax:
Practice Address - Street 1:355 HARLEM RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1825
Practice Address - Country:US
Practice Address - Phone:716-939-7033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1073761041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool