Provider Demographics
NPI:1760154009
Name:CRAUN, TANNER (LMSW)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:CRAUN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 JAY ST BLDG J
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-1153
Mailing Address - Country:US
Mailing Address - Phone:585-328-0873
Mailing Address - Fax:585-436-0103
Practice Address - Street 1:1099 JAY ST BLDG J
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-1153
Practice Address - Country:US
Practice Address - Phone:585-328-0873
Practice Address - Fax:585-436-0103
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112517101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor