Provider Demographics
NPI:1427310937
Name:CRAWFORD, GREGORY DIEHL (PSYD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:DIEHL
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 SHELBY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5556
Mailing Address - Country:US
Mailing Address - Phone:909-935-2385
Mailing Address - Fax:909-935-2685
Practice Address - Street 1:3350 SHELBY ST STE 200
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5556
Practice Address - Country:US
Practice Address - Phone:909-935-2385
Practice Address - Fax:909-935-2685
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28640103G00000X, 103T00000X
CA28640103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical