Provider Demographics
NPI:1366945701
Name:ALDOPHE, CRYSTAL (LMSW)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:ALDOPHE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:CHARLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2675 PARK AVE UNIT 6
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-1357
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2675 PARK AVE UNIT 6
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-1357
Practice Address - Country:US
Practice Address - Phone:203-984-5388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker