Provider Demographics
NPI:1396441440
Name:CRANDON, BRIDGET
Entity type:Individual
Prefix:MISS
First Name:BRIDGET
Middle Name:
Last Name:CRANDON
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 1:3696 STATE ROUTE 14
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:NY
Mailing Address - Zip Code:14489-9346
Mailing Address - Country:US
Mailing Address - Phone:315-879-1861
Mailing Address - Fax:
Practice Address - Street 1:52 WOODSTREAM DR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-1485
Practice Address - Country:US
Practice Address - Phone:716-302-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP119333101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health