1659448330 NPI number — CONSTANCE MARIE CRAIN LICSW

Table of content: CONSTANCE MARIE CRAIN LICSW (NPI 1659448330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659448330 NPI number — CONSTANCE MARIE CRAIN LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAIN
Provider First Name:
CONSTANCE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659448330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
575 BEECH ST
Provider Second Line Business Mailing Address:
BEHAVIORAL HEALTH
Provider Business Mailing Address City Name:
HOLYOKE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01040-2223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-534-2626
Provider Business Mailing Address Fax Number:
413-534-2659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
575 BEECH ST
Provider Second Line Business Practice Location Address:
BEHAVIORAL HEALTH
Provider Business Practice Location Address City Name:
HOLYOKE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01040-2223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-534-2626
Provider Business Practice Location Address Fax Number:
413-534-2659
Provider Enumeration Date:
11/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  110775 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)