Provider Demographics
NPI:1598124331
Name:CRESPO, BARON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BARON
Middle Name:
Last Name:CRESPO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 WESTFIELD BLVD APT 121
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5319
Mailing Address - Country:US
Mailing Address - Phone:855-779-2499
Mailing Address - Fax:855-779-2499
Practice Address - Street 1:463 WESTFIELD BLVD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-5318
Practice Address - Country:US
Practice Address - Phone:855-779-2499
Practice Address - Fax:855-779-2499
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3384-57103T00000X
AL2019103T00000X
TX0000103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist