Healthcare Provider Details

I. General information

NPI: 1477885838
Provider Name (Legal Business Name): EVELYN CRESPO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E 101ST ST 3RD FLOOR
NEW YORK NY
10029-6106
US

IV. Provider business mailing address

7742 MAIN ST 3A
FLUSHING NY
11367-3407
US

V. Phone/Fax

Practice location:
  • Phone: 212-534-8596
  • Fax: 212-860-8407
Mailing address:
  • Phone: 212-534-8596
  • Fax: 212-860-8407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number077147-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: