Provider Demographics
NPI:1508913351
Name:CRESPO, GLORIA MARIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:MARIA
Last Name:CRESPO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 GRUBB ROAD
Mailing Address - Street 2:SUITE #210 BRANDYWOOD PLAZA
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810
Mailing Address - Country:US
Mailing Address - Phone:302-984-2885
Mailing Address - Fax:302-450-7120
Practice Address - Street 1:2500 GRUBB ROAD
Practice Address - Street 2:SUITE #210 BRANDYWOOD PLAZA
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810
Practice Address - Country:US
Practice Address - Phone:302-351-3311
Practice Address - Fax:302-450-7120
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000280103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000459419Medicaid
DE0000459419Medicaid
DE734326Medicare ID - Type UnspecifiedPSYCHOLOGIST