Provider Demographics
NPI:1972196780
Name:CHRYSTAL, JASON (LMSW)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:CHRYSTAL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-2019
Mailing Address - Country:US
Mailing Address - Phone:410-207-4783
Mailing Address - Fax:
Practice Address - Street 1:364 FAIR HILL DR STE E
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-2539
Practice Address - Country:US
Practice Address - Phone:443-687-9976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD268381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical