Provider Demographics
NPI:1003136037
Name:LE, CRYSTAL MARIE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:CRYSTAL
Middle Name:MARIE
Last Name:LE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TRUE
Other - Middle Name:NATURE
Other - Last Name:THERAPY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5203 52ND AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-4709
Mailing Address - Country:US
Mailing Address - Phone:619-339-3644
Mailing Address - Fax:
Practice Address - Street 1:5203 52ND AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-4709
Practice Address - Country:US
Practice Address - Phone:619-339-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA605211041C0700X
MA1274101041C0700X
FL217551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical