MEDICARE: KAREN B CRYSTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW9714	FL

General Provider Information

NPI Number	:	1235451550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN B CRYSTAL

Provider Business Mailing Address
First Line	:	7509 CARMELA WAY
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-5669
Country	:	US
Telephone Number	:	561-699-8099
Fax Number	:

Provider Business Practice Location Address
First Line	:	4205 W ATLANTIC AVE
Second Line	:	SUITE 302
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-3901
Country	:	US
Telephone Number	:	561-699-8099
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2010
Last Update Date	:	03/01/2010

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