Provider Demographics
NPI:1114749140
Name:CRAWFORD, JEAN (PHD, LMT)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PHD, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 AMORY ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2606
Mailing Address - Country:US
Mailing Address - Phone:617-501-5326
Mailing Address - Fax:
Practice Address - Street 1:368 AMORY ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2606
Practice Address - Country:US
Practice Address - Phone:617-501-5326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18366-MT-MT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist