Provider Demographics
NPI:1689313280
Name:CRAWFORD, AMY (LMSW-CC)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 VILLA RD
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3647
Mailing Address - Country:US
Mailing Address - Phone:207-730-0605
Mailing Address - Fax:
Practice Address - Street 1:123 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3850
Practice Address - Country:US
Practice Address - Phone:207-761-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME204041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME20404OtherSTATE OF MAINE - MASTER SOCIAL WORKER - CONDITIONAL CLINICAL LICENSE