Healthcare Provider Details

I. General information

NPI: 1104206945
Provider Name (Legal Business Name): ANDREA CRAYDEN MSW, LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2015
Last Update Date: 06/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 MARKET AVE S
CANTON OH
44702-2165
US

IV. Provider business mailing address

1414 W EASTON RD
BURBANK OH
44214-9580
US

V. Phone/Fax

Practice location:
  • Phone: 330-489-4600
  • Fax:
Mailing address:
  • Phone: 330-466-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI9649
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: