Provider Demographics
NPI:1437251501
Name:CRANE, CAROLE J (PHD, PA)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:J
Last Name:CRANE
Suffix:
Gender:F
Credentials:PHD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 SMITH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4852
Mailing Address - Country:US
Mailing Address - Phone:904-264-7099
Mailing Address - Fax:
Practice Address - Street 1:1680 SMITH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4852
Practice Address - Country:US
Practice Address - Phone:904-264-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2130103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74277Medicare ID - Type UnspecifiedMEDICARE NUMBER