Provider Demographics
NPI:1760075782
Name:CRAWFORD, DAVID (LMSW, CASAC 2)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:LMSW, CASAC 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3739 SHULTS HILL RD
Mailing Address - Street 2:
Mailing Address - City:COHOCTON
Mailing Address - State:NY
Mailing Address - Zip Code:14826-9704
Mailing Address - Country:US
Mailing Address - Phone:607-333-0065
Mailing Address - Fax:
Practice Address - Street 1:3739 SHULTS HILL RD
Practice Address - Street 2:
Practice Address - City:COHOCTON
Practice Address - State:NY
Practice Address - Zip Code:14826-9704
Practice Address - Country:US
Practice Address - Phone:607-333-0065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30307101YA0400X
NY110018104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)