Provider Demographics
NPI:1821122953
Name:CRAWFORD, JACQUELINE BEVERLY (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:BEVERLY
Last Name:CRAWFORD
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 1:7001 CHURCH AVE
Mailing Address - Street 2:UNIT # 27
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-4675
Mailing Address - Country:US
Mailing Address - Phone:951-358-4733
Mailing Address - Fax:
Practice Address - Street 1:9707 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3609
Practice Address - Country:US
Practice Address - Phone:951-358-4733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS164561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical