Provider Demographics
NPI:1639239122
Name:CRAWFORD, ANGELA LYNN (PHD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
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 1:545 POWDERHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-6307
Mailing Address - Country:US
Mailing Address - Phone:607-727-6497
Mailing Address - Fax:
Practice Address - Street 1:1805 VESTAL PKWY E LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1941
Practice Address - Country:US
Practice Address - Phone:607-269-7423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0135530103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
J300054108Medicare UPIN
NY01897341Medicaid