1427513209 NPI number — DR. LARYSSA M CRESWELL MT-BC, LCPC, LPC,ACS

Table of content: DR. LARYSSA M CRESWELL MT-BC, LCPC, LPC,ACS (NPI 1427513209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427513209 NPI number — DR. LARYSSA M CRESWELL MT-BC, LCPC, LPC,ACS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRESWELL
Provider First Name:
LARYSSA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MT-BC, LCPC, LPC,ACS
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:
1427513209
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
139 OLD SOLOMONS ISLAND ROAD
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-9215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-750-1065
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
139 OLD SOLOMONS ISLAND ROAD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-1898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-750-1065
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2019

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: 225A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: LC6298 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com