Healthcare Provider Details

I. General information

NPI: 1760075782
Provider Name (Legal Business Name): DAVID CRAWFORD LMSW, CASAC 2
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2021
Last Update Date: 02/20/2021
Certification Date: 02/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3739 SHULTS HILL RD
COHOCTON NY
14826-9704
US

IV. Provider business mailing address

3739 SHULTS HILL RD
COHOCTON NY
14826-9704
US

V. Phone/Fax

Practice location:
  • Phone: 607-333-0065
  • Fax:
Mailing address:
  • Phone: 607-333-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number30307
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number110018
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: