Provider Demographics
NPI:1659448330
Name:CRAIN, CONSTANCE MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:MARIE
Last Name:CRAIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 BEECH ST
Mailing Address - Street 2:BEHAVIORAL HEALTH
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2223
Mailing Address - Country:US
Mailing Address - Phone:413-534-2626
Mailing Address - Fax:413-534-2659
Practice Address - Street 1:575 BEECH ST
Practice Address - Street 2:BEHAVIORAL HEALTH
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2223
Practice Address - Country:US
Practice Address - Phone:413-534-2626
Practice Address - Fax:413-534-2659
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1107751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACRP22666Medicare ID - Type Unspecified