Provider Demographics
NPI:1295945459
Name:CRAWFORD, SUSAN LAURA (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LAURA
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 TERRA LN
Mailing Address - Street 2:
Mailing Address - City:PACHECO
Mailing Address - State:CA
Mailing Address - Zip Code:94553-5579
Mailing Address - Country:US
Mailing Address - Phone:510-326-8588
Mailing Address - Fax:
Practice Address - Street 1:2001 SALVIO ST STE 28
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2495
Practice Address - Country:US
Practice Address - Phone:510-326-8588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12489104100000X
CA244131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker