Provider Demographics
NPI:1902671084
Name:CRICHLOW, DEREK DESMOND JR
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:DESMOND
Last Name:CRICHLOW
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4127
Mailing Address - Country:US
Mailing Address - Phone:631-994-8775
Mailing Address - Fax:
Practice Address - Street 1:330 W 58TH ST STE 401
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1821
Practice Address - Country:US
Practice Address - Phone:212-575-4769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical