Basic Information
| Provider Information | |||||||||
| NPI: | 1972145605 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRESPIN | ||||||||
| FirstName: | DAVID | ||||||||
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| Mailing Information | |||||||||
| Address1: | 290 QUARRY ST APT 214 | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021694156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604028048 | ||||||||
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| Practice Location | |||||||||
| Address1: | 859 WILLARD ST | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021697482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178471909 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2019 | ||||||||
| LastUpdateDate: | 10/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator | 103TC1900X | N | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TF0000X | N | Behavioral Health & Social Service Providers | Psychologist | Family | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.