Provider Demographics
NPI:1164857546
Name:CRADDOCK, JAIH B (PHD, MSW, MA)
Entity type:Individual
Prefix:DR
First Name:JAIH
Middle Name:B
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:PHD, MSW, MA
Other - Prefix:
Other - First Name:JAIH
Other - Middle Name:B
Other - Last Name:MCREYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 52952
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-2952
Mailing Address - Country:US
Mailing Address - Phone:510-926-8412
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 52952
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92619-2952
Practice Address - Country:US
Practice Address - Phone:510-926-8412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW982721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty