Provider Demographics
NPI:1902936321
Name:CRIMMINS, CAROLYN FRANCES (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:FRANCES
Last Name:CRIMMINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:FRANCES
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1260 N DUTTON AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4659
Mailing Address - Country:US
Mailing Address - Phone:707-526-5424
Mailing Address - Fax:707-526-5900
Practice Address - Street 1:1260 N DUTTON AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4659
Practice Address - Country:US
Practice Address - Phone:707-526-5424
Practice Address - Fax:707-526-5900
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23205103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGP312AMedicare PIN