Provider Demographics
NPI:1366623019
Name:CRYSTAL, ARLENE B (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:B
Last Name:CRYSTAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ARLENE
Other - Middle Name:BASIK
Other - Last Name:CRYSTAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2880 W OAKLAND PARK BLVD
Mailing Address - Street 2:#226
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1354
Mailing Address - Country:US
Mailing Address - Phone:561-818-3421
Mailing Address - Fax:954-739-5427
Practice Address - Street 1:2880 W OAKLAND PARK BLVD
Practice Address - Street 2:#226
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1354
Practice Address - Country:US
Practice Address - Phone:561-818-3421
Practice Address - Fax:954-739-5427
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW54371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ0347OtherBLUECROSS BLUE SHIELD
FLE2421Medicare PIN