Healthcare Provider Details

I. General information

NPI: 1477210946
Provider Name (Legal Business Name): CRYSTAL N HUTCHINSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 20TH PL
VERO BEACH FL
32960-3296
US

IV. Provider business mailing address

902 20TH PL
VERO BEACH FL
32960
US

V. Phone/Fax

Practice location:
  • Phone: 772-519-6387
  • Fax:
Mailing address:
  • Phone: 772-519-6387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18711
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: