Provider Demographics
NPI:1720103807
Name:CRAFT, KAERENSA ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:KAERENSA
Middle Name:ANNE
Last Name:CRAFT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 LEXINGTON AVE
Mailing Address - Street 2:BOX 313
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1145
Mailing Address - Country:US
Mailing Address - Phone:917-797-4736
Mailing Address - Fax:
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:SUITE 1021
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:917-797-4736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR060918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY76882751OtherAETNA BEH HEALTH PROV#
NY553577OtherVALUE OPTIONS #
NY7351122OtherGHI BEH. HEALTH PROV#
NYP3441287OtherOXFORD BEH. HEALTH PROV#