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NPI Code Detail

MEDICARE: ALBERT N CRANE JR.

MEDICARE: ALBERT N CRANE JR.
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1902031859
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALBERT N CRANE JR.
Provider Business Mailing Address
First Line : 623 BEECHWOOD ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32206-6236
Country : US
Telephone Number : 904-358-1211
Fax Number : 904-358-1558
Provider Business Practice Location Address
First Line : 623 BEECHWOOD ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32206-6236
Country : US
Telephone Number : 904-358-1211
Fax Number : 904-358-1558
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2009
Last Update Date : 05/21/2009

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