Provider Demographics
NPI:1881202489
Name:CRAVEN, PAIGE ALICE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:ALICE
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FORDHAM RD STE 2
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-3000
Mailing Address - Country:US
Mailing Address - Phone:617-782-6460
Mailing Address - Fax:617-782-6457
Practice Address - Street 1:14 FORDHAM RD STE 2
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-3000
Practice Address - Country:US
Practice Address - Phone:617-782-6460
Practice Address - Fax:617-782-6457
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2428602363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health