Healthcare Provider Details

I. General information

NPI: 1215625652
Provider Name (Legal Business Name): CRYSTAL MCCROREY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WESTCHESTER SQ LOWR LEVEL
BRONX NY
10461-3525
US

IV. Provider business mailing address

55 WESTCHESTER SQ LOWR LEVEL
BRONX NY
10461-3525
US

V. Phone/Fax

Practice location:
  • Phone: 718-931-4045
  • Fax: 718-884-8096
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: