Provider Demographics
NPI:1952866519
Name:WELCH-SCOTT, CRYSTAL M (LCSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:WELCH-SCOTT
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 1:10L GARDEN TER
Mailing Address - Street 2:
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-8211
Mailing Address - Country:US
Mailing Address - Phone:917-582-0670
Mailing Address - Fax:
Practice Address - Street 1:460 W 41ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6801
Practice Address - Country:US
Practice Address - Phone:212-613-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087322-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical