Provider Demographics
NPI:1942345608
Name:CRANE, D. MICHAEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:D.
Middle Name:MICHAEL
Last Name:CRANE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DENNIS
Other - Middle Name:M
Other - Last Name:CRANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:97 EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-1900
Mailing Address - Country:US
Mailing Address - Phone:401-228-6424
Mailing Address - Fax:
Practice Address - Street 1:154 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3116
Practice Address - Country:US
Practice Address - Phone:401-273-3322
Practice Address - Fax:401-270-5700
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00960103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI413766OtherBLUECROSS-BLUECHIP
RI31963-6OtherBLUECROSS-BLUESHIELD OF R