Provider Demographics
NPI:1619171402
Name:CRAWFORD, DOROTHY M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:M
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 E 11TH ST
Mailing Address - Street 2:4TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4602
Mailing Address - Country:US
Mailing Address - Phone:212-777-1223
Mailing Address - Fax:212-477-2040
Practice Address - Street 1:41 E 11TH ST
Practice Address - Street 2:4TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4602
Practice Address - Country:US
Practice Address - Phone:212-777-1223
Practice Address - Fax:212-477-2040
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7231103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01276457Medicaid
NY01276457Medicaid