Provider Demographics
NPI:1194427153
Name:TAYLOR, CRYSTAL RENNITA
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:RENNITA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-2022
Mailing Address - Country:US
Mailing Address - Phone:401-834-5247
Mailing Address - Fax:
Practice Address - Street 1:66 BURNETT ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-2527
Practice Address - Country:US
Practice Address - Phone:401-785-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor