Provider Demographics
NPI:1790837029
Name:CRANWILL, PATRICIA A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:CRANWILL
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 1:16441 YORK ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-7621
Mailing Address - Country:US
Mailing Address - Phone:303-915-4973
Mailing Address - Fax:303-280-6969
Practice Address - Street 1:500 COFFMAN STR
Practice Address - Street 2:STE 207
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501
Practice Address - Country:US
Practice Address - Phone:303-915-4973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9998261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COB5109Medicare PIN