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General NPI Number Information
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NPI Number | 1902671084
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Entity Type | Individual
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Provider Name | MR. DEREK DESMOND CRICHLOW JR.
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Gender | Male
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Dates
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Enumeration Date | 11/20/2023
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 330 W 58TH ST STE 401
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City | NEW YORK
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State | NY
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Zip | 10019-1821
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Country | US
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Telephone | 212-575-4769
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Fax |
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Provider Business Mailing Address
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Address Line | 75 SMITH ST
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City | CENTRAL ISLIP
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State | NY
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Zip | 11722-4127
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Country | US
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Telephone | 631-994-8775
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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