Provider Demographics
NPI:1669528774
Name:CRESPO, ELBA IRIS (PHD)
Entity type:Individual
Prefix:MS
First Name:ELBA
Middle Name:IRIS
Last Name:CRESPO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 HIGH PARK AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-5642
Mailing Address - Country:US
Mailing Address - Phone:036-856-4862
Mailing Address - Fax:
Practice Address - Street 1:1506 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5916
Practice Address - Country:US
Practice Address - Phone:203-685-6486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002555103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT330606OtherMHN
CT060002555CT01OtherANTHEM BC