Provider Demographics
NPI:1558870089
Name:CRAWFORD, CHARLES (LMHC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6275 BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14425-9550
Mailing Address - Country:US
Mailing Address - Phone:585-314-0305
Mailing Address - Fax:
Practice Address - Street 1:6275 BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NY
Practice Address - Zip Code:14425-9550
Practice Address - Country:US
Practice Address - Phone:585-314-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004973101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional