Provider Demographics
NPI:1518363936
Name:CHAVONE LORRAINE CRESPO
Entity Type:Organization
Organization Name:CHAVONE LORRAINE CRESPO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAVONE
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:CRESPO
Authorized Official - Suffix:
Authorized Official - Credentials:MHC
Authorized Official - Phone:212-368-6759
Mailing Address - Street 1:211 E 43RD ST
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4707
Mailing Address - Country:US
Mailing Address - Phone:212-368-6759
Mailing Address - Fax:212-682-3952
Practice Address - Street 1:211 E 43RD ST
Practice Address - Street 2:SUITE 1101
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4707
Practice Address - Country:US
Practice Address - Phone:212-368-6759
Practice Address - Fax:212-682-3952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP92787251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health