Provider Demographics
NPI:1689705923
Name:CRAWFORD, DOUGLAS RAYMOND (EDD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:RAYMOND
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2520
Mailing Address - Country:US
Mailing Address - Phone:856-547-6700
Mailing Address - Fax:856-546-7362
Practice Address - Street 1:408 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:NJ
Practice Address - Zip Code:08106-1311
Practice Address - Country:US
Practice Address - Phone:856-547-6700
Practice Address - Fax:856-546-7362
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100196400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJUPIN IDP81267Medicare ID - Type Unspecified