Provider Demographics
NPI:1336965615
Name:CRAIG, CATHERINE (CLC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3076 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-4640
Mailing Address - Country:US
Mailing Address - Phone:516-313-4949
Mailing Address - Fax:
Practice Address - Street 1:3076 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-4640
Practice Address - Country:US
Practice Address - Phone:516-313-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA361072174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN