Provider Demographics
NPI:1417015041
Name:CRYSTAL, SYDNEY OBEDIN (MSW)
Entity Type:Individual
Prefix:MS
First Name:SYDNEY
Middle Name:OBEDIN
Last Name:CRYSTAL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-4217
Mailing Address - Country:US
Mailing Address - Phone:802-258-8242
Mailing Address - Fax:802-488-5714
Practice Address - Street 1:352 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-4217
Practice Address - Country:US
Practice Address - Phone:802-258-8242
Practice Address - Fax:802-488-5714
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00006981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007172Medicaid
VT1007172Medicaid