Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1225672140 |
---|---|
Provider Name | Edrid Joel Crespo |
First Address | Kissimmee, FL 34744-3730 |
Second Address | Kissimmee, FL 34744-3730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2019 |
Last Update Date | 30/06/2020 |