MEDICARE: SHARON LOUISE CRANE

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	101YM0800X	Mental Health Counselor	IMH 12179	FL

General Provider Information

NPI Number	:	1487073326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON LOUISE CRANE

Provider Business Mailing Address
First Line	:	161 TURNBERRY CIR
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7938
Country	:	US
Telephone Number	:	386-314-6482
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 TURNBERRY CIR
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7938
Country	:	US
Telephone Number	:	386-314-6482
Fax Number	:

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

Provider Enumeration Date	:	04/08/2014
Last Update Date	:	04/08/2014

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