Healthcare Provider Details

I. General information

NPI: 1356669097
Provider Name (Legal Business Name): CORIE LEON CREWS SR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 E MAIN ST STE 4
PATCHOGUE NY
11772-3165
US

IV. Provider business mailing address

PO BOX 586
MEDFORD NY
11763-0586
US

V. Phone/Fax

Practice location:
  • Phone: 516-369-9265
  • Fax:
Mailing address:
  • Phone: 631-364-9560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: