Provider Demographics
NPI:1700827045
Name:CRANE, GLORIA E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:E
Last Name:CRANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 LIVONIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-1127
Mailing Address - Country:US
Mailing Address - Phone:310-838-3380
Mailing Address - Fax:310-837-3625
Practice Address - Street 1:1912 LIVONIA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1127
Practice Address - Country:US
Practice Address - Phone:310-838-3380
Practice Address - Fax:310-837-3625
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2009-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 129951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW12995Medicare PIN