Provider Demographics
NPI:1417184854
Name:CRISPIN, SANDRA JEAN
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:CRISPIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 RED BROOK RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-5700
Mailing Address - Country:US
Mailing Address - Phone:508-759-1840
Mailing Address - Fax:
Practice Address - Street 1:2 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3964
Practice Address - Country:US
Practice Address - Phone:508-830-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)