Provider Demographics
NPI:1689991135
Name:CAROLE J CRANE PHD PA
Entity Type:Organization
Organization Name:CAROLE J CRANE PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-264-7099
Mailing Address - Street 1:1680 SMITH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4852
Mailing Address - Country:US
Mailing Address - Phone:904-264-7099
Mailing Address - Fax:
Practice Address - Street 1:1680 SMITH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4852
Practice Address - Country:US
Practice Address - Phone:904-264-7099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY00002130261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health