Provider Demographics
NPI:1023663325
Name:CRAWL, DEMAREST
Entity type:Individual
Prefix:
First Name:DEMAREST
Middle Name:
Last Name:CRAWL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3803
Mailing Address - Country:US
Mailing Address - Phone:240-319-0182
Mailing Address - Fax:240-319-0182
Practice Address - Street 1:1808 61ST AVE
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-3803
Practice Address - Country:US
Practice Address - Phone:240-319-0182
Practice Address - Fax:240-319-0182
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500822631041C0700X
MD223891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical