Provider Demographics
NPI:1619070034
Name:ROWE, CRAYTON EDWARD JR (MSW)
Entity Type:Individual
Prefix:MR
First Name:CRAYTON
Middle Name:EDWARD
Last Name:ROWE
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 WEST END AVE
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3662
Mailing Address - Country:US
Mailing Address - Phone:212-877-2005
Mailing Address - Fax:212-877-2005
Practice Address - Street 1:230 WEST END AVE
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3662
Practice Address - Country:US
Practice Address - Phone:212-877-2005
Practice Address - Fax:212-877-2005
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR000622-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN08941Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER