Provider Demographics
NPI:1285869958
Name:CRESCENT PSYCHIATRY
Entity type:Organization
Organization Name:CRESCENT PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VANRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:VARU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-514-8076
Mailing Address - Street 1:7191 WAGNER WAY NW
Mailing Address - Street 2:SUITE # 301
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-6909
Mailing Address - Country:US
Mailing Address - Phone:253-514-8076
Mailing Address - Fax:253-514-8078
Practice Address - Street 1:7191 WAGNER WAY NW
Practice Address - Street 2:SUITE # 301
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-6909
Practice Address - Country:US
Practice Address - Phone:253-514-8076
Practice Address - Fax:253-514-8078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-23
Last Update Date:2009-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD30816261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF40178Medicare UPIN