Provider Demographics
NPI:1457740870
Name:CRAWFORD-GREY, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CRAWFORD-GREY
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 1:425 LAKE AVE N
Mailing Address - Street 2:STE 101
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2047
Mailing Address - Country:US
Mailing Address - Phone:508-753-3220
Mailing Address - Fax:508-753-3224
Practice Address - Street 1:425 LAKE AVE N
Practice Address - Street 2:STE 101
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2047
Practice Address - Country:US
Practice Address - Phone:508-753-3220
Practice Address - Fax:508-753-3224
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2263974363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health