Provider Demographics
NPI:1720547680
Name:CROSSEN, CRYSTAL A (PEER RECOVERY SPECIA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:A
Last Name:CROSSEN
Suffix:
Gender:F
Credentials:PEER RECOVERY SPECIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2756 POST ROAD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-691-6000
Mailing Address - Fax:401-691-3398
Practice Address - Street 1:344 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-272-3018
Practice Address - Fax:401-272-1099
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist