Provider Demographics
NPI:1700938875
Name:CRAWFORD, THOMAS (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 BERNAL RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1343
Mailing Address - Country:US
Mailing Address - Phone:408-362-4351
Mailing Address - Fax:408-362-4355
Practice Address - Street 1:175 BERNAL RD
Practice Address - Street 2:STE 230
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1343
Practice Address - Country:US
Practice Address - Phone:408-362-4350
Practice Address - Fax:408-362-4355
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19973103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical