Provider Demographics
NPI:1265437941
Name:CRISPELL, JANE KATHRYN (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:KATHRYN
Last Name:CRISPELL
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 HANSHAW RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1530
Mailing Address - Country:US
Mailing Address - Phone:607-280-5850
Mailing Address - Fax:
Practice Address - Street 1:903 HANSHAW RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1530
Practice Address - Country:US
Practice Address - Phone:607-280-5850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059542104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker