Provider Demographics
NPI:1013154731
Name:GAUEN, CRYSTAL L (LCAT)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:L
Last Name:GAUEN
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E 118TH ST
Mailing Address - Street 2:APT. 2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-4184
Mailing Address - Country:US
Mailing Address - Phone:917-407-0890
Mailing Address - Fax:
Practice Address - Street 1:406 E 176TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-6003
Practice Address - Country:US
Practice Address - Phone:718-901-6847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001179221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist