Provider Demographics
NPI:1356669097
Name:CREWS, CORIE LEON SR (MSW)
Entity Type:Individual
Prefix:MR
First Name:CORIE
Middle Name:LEON
Last Name:CREWS
Suffix:SR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-0753
Mailing Address - Country:US
Mailing Address - Phone:631-364-9560
Mailing Address - Fax:631-772-4620
Practice Address - Street 1:1444 FIFTH AVENUE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-647-2048
Practice Address - Fax:631-647-2057
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker