Healthcare Provider Details

I. General information

NPI: 1245024454
Provider Name (Legal Business Name): ELIZABETH CRAWFORD ASW, PPSC, CWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 N MAIN ST
SOQUEL CA
95073-2212
US

IV. Provider business mailing address

620 MONTEREY AVE
CAPITOLA CA
95010-3618
US

V. Phone/Fax

Practice location:
  • Phone: 831-464-5650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number126932
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number126932
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: