Provider Demographics
NPI:1366779696
Name:CRAWFORD, AYANNA C (MED)
Entity type:Individual
Prefix:MS
First Name:AYANNA
Middle Name:C
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MS
Other - First Name:AYANNA
Other - Middle Name:
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:88 LAWTON STREET
Mailing Address - Street 2:APT # 1
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109
Mailing Address - Country:US
Mailing Address - Phone:413-886-9089
Mailing Address - Fax:
Practice Address - Street 1:155 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1828
Practice Address - Country:US
Practice Address - Phone:413-886-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health