Provider Demographics
NPI:1306578596
Name:RIVERA-CRONIN, CRYSTAL (LCMHC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:RIVERA-CRONIN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:DANIELLE
Other - Last Name:RIVERA-CRONIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHC
Mailing Address - Street 1:203 E NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-3004
Mailing Address - Country:US
Mailing Address - Phone:631-942-6700
Mailing Address - Fax:
Practice Address - Street 1:2233 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-1000
Practice Address - Country:US
Practice Address - Phone:631-942-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health