Provider Demographics
NPI:1568903003
Name:CRANDALL, PATRICIA JENNIE (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JENNIE
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4304
Mailing Address - Country:US
Mailing Address - Phone:386-236-3225
Mailing Address - Fax:352-565-4131
Practice Address - Street 1:107 DR MARTIN LUTHER KING JR AVE STE 1
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-4300
Practice Address - Country:US
Practice Address - Phone:800-539-4228
Practice Address - Fax:352-565-4131
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW142531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical