Healthcare Provider Details

I. General information

NPI: 1548349285
Provider Name (Legal Business Name): GINA CRAWFORD PH D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23818 CLIFF DR
BAY VILLAGE OH
44140-2907
US

IV. Provider business mailing address

23818 CLIFF DR
BAY VILLAGE OH
44140-2907
US

V. Phone/Fax

Practice location:
  • Phone: 440-570-9653
  • Fax: 440-874-6025
Mailing address:
  • Phone: 440-570-9653
  • Fax: 440-874-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6035
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: