Provider Demographics
NPI:1144312489
Name:CRANDELL, JOHN SMITH (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SMITH
Last Name:CRANDELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S CAMERON ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4732
Mailing Address - Country:US
Mailing Address - Phone:540-722-0750
Mailing Address - Fax:540-722-0751
Practice Address - Street 1:125 S CAMERON ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4732
Practice Address - Country:US
Practice Address - Phone:540-722-0750
Practice Address - Fax:540-722-0751
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001152103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA336700OtherANTHEM BC/BS
VA680001310Medicare ID - Type Unspecified