MEDICARE: IEESHA CRAWFORD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW15240	FL

General Provider Information

NPI Number	:	1083364152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IEESHA CRAWFORD LCSW

Provider Business Mailing Address
First Line	:	1130 SW 7TH AVE
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-6319
Country	:	US
Telephone Number	:	954-803-8111
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 W STATE ROAD 84
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-2433
Country	:	US
Telephone Number	:	754-900-8280
Fax Number	:	949-862-3411

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	03/24/2022

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Directions to “ IEESHA CRAWFORD LCSW” Practice Location

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