Provider Demographics
NPI:1417259672
Name:CRAWFORD, THERESA CHRISTINA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:CHRISTINA
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:CHRISTINA
Other - Last Name:VOGL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:292 WASHINTON AVENUE EXTENSION
Mailing Address - Street 2:110
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203
Mailing Address - Country:US
Mailing Address - Phone:518-934-2201
Mailing Address - Fax:
Practice Address - Street 1:292 WASHINGTON AVENUE EXTENSION
Practice Address - Street 2:110
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203
Practice Address - Country:US
Practice Address - Phone:518-934-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-21
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA171100000X
NY005701-1171100000X
ORAC181609171100000X
NY005701171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist