Provider Demographics
NPI:1346755063
Name:CROWN, DAVID LAWERENCE (CASAC-TRAINEE)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LAWERENCE
Last Name:CROWN
Suffix:
Gender:M
Credentials:CASAC-TRAINEE
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:LAWERENCE
Other - Last Name:CROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASAC TRAINEE
Mailing Address - Street 1:62 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-6844
Mailing Address - Country:US
Mailing Address - Phone:212-343-3591
Mailing Address - Fax:
Practice Address - Street 1:62 E BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-6844
Practice Address - Country:US
Practice Address - Phone:212-343-3591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28529101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY28529OtherCASAC TRAINEE