Provider Demographics
NPI:1518073188
Name:CRUTCHFIELD, GLORIA PINZON (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:PINZON
Last Name:CRUTCHFIELD
Suffix:
Gender:F
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:PO BOX 605
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-0605
Mailing Address - Country:US
Mailing Address - Phone:727-736-3132
Mailing Address - Fax:727-736-3052
Practice Address - Street 1:1613 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-4759
Practice Address - Country:US
Practice Address - Phone:727-736-3132
Practice Address - Fax:727-736-3052
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5217103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59858AMedicare ID - Type Unspecified