Provider Demographics
NPI:1023168564
Name:LENNON, CRAIG (PHD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:LENNON
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:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-0730
Mailing Address - Country:US
Mailing Address - Phone:518-943-4360
Mailing Address - Fax:
Practice Address - Street 1:35 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-2109
Practice Address - Country:US
Practice Address - Phone:518-943-4360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0110841103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV8A191Medicare ID - Type Unspecified