Provider Demographics
NPI:1639572209
Name:CRUMPTON, DOREEN HENDRIE
Entity Type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:HENDRIE
Last Name:CRUMPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23874 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CALCIUM
Mailing Address - State:NY
Mailing Address - Zip Code:13616-2205
Mailing Address - Country:US
Mailing Address - Phone:315-804-1620
Mailing Address - Fax:315-772-6229
Practice Address - Street 1:11050 MOUNT BELVEDERE BLVD
Practice Address - Street 2:
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13602-5438
Practice Address - Country:US
Practice Address - Phone:315-772-9684
Practice Address - Fax:315-772-6229
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57370104100000X
NCP0079711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker