Provider Demographics
NPI:1366910341
Name:CLIFFORD, CRYSTAL LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LYNN
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:LYNN
Other - Last Name:SONNATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:375 HARMONY HILL RD
Mailing Address - Street 2:
Mailing Address - City:HARWINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06791-1417
Mailing Address - Country:US
Mailing Address - Phone:860-605-3885
Mailing Address - Fax:
Practice Address - Street 1:375 HARMONY HILL RD
Practice Address - Street 2:
Practice Address - City:HARWINTON
Practice Address - State:CT
Practice Address - Zip Code:06791-1417
Practice Address - Country:US
Practice Address - Phone:860-605-3885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4549104100000X
CT1328101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker