Provider Demographics
NPI:1982737763
Name:SHERMAN CRANDELL, GAYLE (MA)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:
Last Name:SHERMAN CRANDELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3014
Mailing Address - Country:US
Mailing Address - Phone:612-819-0556
Mailing Address - Fax:
Practice Address - Street 1:1133 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2629
Practice Address - Country:US
Practice Address - Phone:651-641-0177
Practice Address - Fax:651-641-8635
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPCC00068103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling