Provider Demographics
NPI:1891933628
Name:STEVENS, CRAIG (MA, MT-BC, NMT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MA, MT-BC, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W 36TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2904
Mailing Address - Country:US
Mailing Address - Phone:814-877-3682
Mailing Address - Fax:
Practice Address - Street 1:124 W 36TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2904
Practice Address - Country:US
Practice Address - Phone:814-877-3682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA08471225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist