Healthcare Provider Details

I. General information

NPI: 1477552297
Provider Name (Legal Business Name): ROBERT ALOYSIUS CRIMMINS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 JUSTICE LN
BUNNELL FL
32110-4487
US

IV. Provider business mailing address

20 SANDPIPER LN
ORMOND BEACH FL
32174-4264
US

V. Phone/Fax

Practice location:
  • Phone: 386-236-3265
  • Fax:
Mailing address:
  • Phone: 386-676-1745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW3326
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: