Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 18704 | CA |
NPI | 1831766153 |
---|---|
Provider Name | Jason Crawford |
First Address | San Francisco, CA 94109-4906 |
Second Address | San Francisco, CA 94110-3518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2021 |
Last Update Date | 06/06/2021 |