1235751959 NPI number — KATHERINE MARIAH CRAWFORD MS, CGC

Table of content: KATHERINE MARIAH CRAWFORD MS, CGC (NPI 1235751959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235751959 NPI number — KATHERINE MARIAH CRAWFORD MS, CGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAWFORD
Provider First Name:
KATHERINE
Provider Middle Name:
MARIAH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, CGC
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:
1235751959
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 TOLL GATE RD
Provider Second Line Business Mailing Address:
PRC AND CREDENTIALING
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-2759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-273-0641
Provider Business Mailing Address Fax Number:
401-273-2919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BLACKSTONE STREET, 2ND FLOOR
Provider Second Line Business Practice Location Address:
WIH BREAST HEALTH CENTER
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-453-7520
Provider Business Practice Location Address Fax Number:
401-453-7529
Provider Enumeration Date:
05/15/2020

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: 170300000X , with the licence number:  GC00006 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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