Provider Demographics
NPI:1992796098
Name:CRESCI, MARY BETH MCLAUGHLIN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY BETH
Middle Name:MCLAUGHLIN
Last Name:CRESCI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PINEAPPLE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1615
Mailing Address - Country:US
Mailing Address - Phone:718-625-0221
Mailing Address - Fax:
Practice Address - Street 1:10 PINEAPPLE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1615
Practice Address - Country:US
Practice Address - Phone:718-625-0221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004660-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0093630OtherGHI
NY147299OtherVALUE OPTIONS
NY0093630OtherGHI