MEDICARE: DAPHNE DIANE CRAWFORD LCSW

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	00000004842	TN
2	1041C0700X	Clinical Social Worker	4842	TN

General Provider Information

NPI Number	:	1740461110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAPHNE DIANE CRAWFORD LCSW

Provider Business Mailing Address
First Line	:	301 HIGGINS AVE STE 108
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-3006
Country	:	US
Telephone Number	:	865-888-6451
Fax Number	:	865-544-8209

Provider Business Practice Location Address
First Line	:	301 HIGGINS AVE STE 108
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-3006
Country	:	US
Telephone Number	:	865-888-6451
Fax Number	:	865-544-8209

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

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	04/27/2023

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