Provider Demographics
NPI:1245871375
Name:IRVING-CRUICKSHANK, FELICIA DENISE
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:DENISE
Last Name:IRVING-CRUICKSHANK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 W 15TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6701
Mailing Address - Country:US
Mailing Address - Phone:212-924-6320
Mailing Address - Fax:646-306-0513
Practice Address - Street 1:145 W 15TH ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6701
Practice Address - Country:US
Practice Address - Phone:212-924-6320
Practice Address - Fax:646-477-4094
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082066104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker