Provider Demographics
NPI:1437885100
Name:CROSSMAN, JUSTIN REID (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:REID
Last Name:CROSSMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GROVE PL APT 3
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-1547
Mailing Address - Country:US
Mailing Address - Phone:315-525-3228
Mailing Address - Fax:
Practice Address - Street 1:1675 BENNETT ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5390
Practice Address - Country:US
Practice Address - Phone:315-525-3228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist