Provider Demographics
NPI:1306972906
Name:CREWS, WANDA J
Entity type:Individual
Prefix:DR
First Name:WANDA
Middle Name:J
Last Name:CREWS
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 1:870 LENAPE RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-2143
Mailing Address - Country:US
Mailing Address - Phone:610-357-7474
Mailing Address - Fax:
Practice Address - Street 1:870 LENAPE RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-2143
Practice Address - Country:US
Practice Address - Phone:610-357-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003078L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0072380290002Medicaid
PA534468OtherBLUE CROSS BLUE SHIELD
PA534468Medicare ID - Type Unspecified