Healthcare Provider Details

I. General information

NPI: 1033107263
Provider Name (Legal Business Name): ANNETTE MARIA CRAWFORD MSW,LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 MCCORMACK DR
LAKE GEORGE NY
12845-3425
US

IV. Provider business mailing address

98 MCCORMACK DR
LAKE GEORGE NY
12845-3425
US

V. Phone/Fax

Practice location:
  • Phone: 518-792-4167
  • Fax: 518-792-4125
Mailing address:
  • Phone: 518-792-4167
  • Fax: 518-792-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR029866-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: