Provider Demographics
NPI:1902956659
Name:CRUMPLER, LAVERNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAVERNE
Middle Name:
Last Name:CRUMPLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 W 86 STREET
Mailing Address - Street 2:STE 1004
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3616
Mailing Address - Country:US
Mailing Address - Phone:212-787-6865
Mailing Address - Fax:212-787-6865
Practice Address - Street 1:21 W 86 STREET
Practice Address - Street 2:STE 1004
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3616
Practice Address - Country:US
Practice Address - Phone:212-787-6865
Practice Address - Fax:212-787-6865
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02784511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN75011Medicare ID - Type Unspecified