Provider Demographics
NPI:1508490343
Name:OVIEDO, CRYSTAL MARIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:MARIE
Last Name:OVIEDO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-7706
Mailing Address - Country:US
Mailing Address - Phone:347-641-9158
Mailing Address - Fax:
Practice Address - Street 1:157 WILSON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7706
Practice Address - Country:US
Practice Address - Phone:718-302-4018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108964-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker