Provider Demographics
NPI:1255473831
Name:CRAIN, DEREK A (MSW)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:A
Last Name:CRAIN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6505 216TH ST SW STE 100
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2089
Mailing Address - Country:US
Mailing Address - Phone:425-640-7009
Mailing Address - Fax:425-678-6455
Practice Address - Street 1:6505 216TH ST SW STE 100
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2089
Practice Address - Country:US
Practice Address - Phone:425-640-7009
Practice Address - Fax:425-678-6455
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000093541041C0700X
NV10590-C1041C0700X
TX1114581041C0700X
UT13348744-35011041C0700X
OHI.23049331041C0700X
ORL85261041C0700X
MN324941041C0700X
FLSW214141041C0700X
COCSW.099290191041C0700X
NMSWB-2023-03761041C0700X
IL1490258641041C0700X
IDLCSW-437281041C0700X
AZLCSW-212951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical