Basic Information
Provider Information | |||||||||
NPI: | 1699030650 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CRAVER-DEAN | ||||||||
FirstName: | ERIN | ||||||||
MiddleName: | P | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPCC-S | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DEAN | ||||||||
OtherFirstName: | ERIN | ||||||||
OtherMiddleName: | P | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 5338 MEADOW LANE CT | ||||||||
Address2: |   | ||||||||
City: | SHEFFIELD VILLAGE | ||||||||
State: | OH | ||||||||
PostalCode: | 440351469 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2162823838 | ||||||||
FaxNumber: | 2168014370 | ||||||||
Practice Location | |||||||||
Address1: | 5338 MEADOW LANE CT | ||||||||
Address2: |   | ||||||||
City: | SHEFFIELD VILLAGE | ||||||||
State: | OH | ||||||||
PostalCode: | 440351469 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2162823838 | ||||||||
FaxNumber: | 2168014370 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/05/2012 | ||||||||
LastUpdateDate: | 09/23/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/23/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E0500046 | OH | Y |   | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
ID | Type | State | Issuer | Description | 0169170 | 05 | OH |   | MEDICAID |