Provider Demographics
NPI:1609111814
Name:CRANE, MICHAEL L (MA, NCSP, LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:CRANE
Suffix:
Gender:M
Credentials:MA, NCSP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 N. BROAD ST.
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:860-965-7743
Mailing Address - Fax:203-951-3653
Practice Address - Street 1:426 TAULMAN RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477
Practice Address - Country:US
Practice Address - Phone:860-965-7743
Practice Address - Fax:203-713-3244
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002282101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional