Doctor Name: | MANDY CRANDALL |
NPI Number: | 1033428099 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LICSW |
License Number: | ISW01952 |
Business Practice Address: | 35 Dorman Ave North Providence, RI - 029043608 |
Business Phone Number: | 4012632885 |
Business Fax Number: | |
Mailing Address: | 35 Dorman Avenue, NORTH PROVIDENCE |
State: | RI |
Postal Code: | 02904 |
Phone Number: | 4012632885 |
Fax Number: | |
NPI Enumeration Date: | 09/24/2010 |
NPI Last Update Date: | 09/24/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | ISW01952 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | RI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |