Provider Demographics
NPI:1942948492
Name:SANDERS, CRYSTAL M
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:M
Other - Last Name:CASTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4121 PATRIOT WAY
Mailing Address - Street 2:
Mailing Address - City:WEST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02817-6094
Mailing Address - Country:US
Mailing Address - Phone:985-870-5884
Mailing Address - Fax:
Practice Address - Street 1:4121 PATRIOT WAY
Practice Address - Street 2:
Practice Address - City:WEST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02817-6094
Practice Address - Country:US
Practice Address - Phone:985-870-5884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2024-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW03149104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker