Provider Demographics
NPI:1467007401
Name:SHAUN CRIMMINS LCSW, PLLC
Entity Type:Organization
Organization Name:SHAUN CRIMMINS LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:716-650-4797
Mailing Address - Street 1:1416 SWEET HOME RD STE 1
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2786
Mailing Address - Country:US
Mailing Address - Phone:716-650-4797
Mailing Address - Fax:716-608-1437
Practice Address - Street 1:1416 SWEET HOME RD STE 1
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2786
Practice Address - Country:US
Practice Address - Phone:716-650-4797
Practice Address - Fax:716-608-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04033776Medicaid