Healthcare Provider Details

I. General information

NPI: 1164948865
Provider Name (Legal Business Name): DANNY CRUM PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S QUEEN ST
MARTINSBURG WV
25401-3233
US

IV. Provider business mailing address

BERKELEY COUNTY BOE 401 SOUTH QUEEN STREET 401 SOUTH QUEEN STREET
MARTINSBURG WV
25414
US

V. Phone/Fax

Practice location:
  • Phone: 304-267-3595
  • Fax: 304-267-3599
Mailing address:
  • Phone: 304-267-3595
  • Fax: 304-267-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberR7N140800091
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: