Active NPI
Sally J Crumly, LCSW
- Clinical Social Worker
- Winter Park, FL
National Provider Identifier
1053557587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW4672
- Practice address
- 1954 Howell Branch Rd
106
Winter Park, FL 32792-1041 - Phone
- (407) 657-8555
- Fax
- (407) 657-5774
- NPI assigned
- Jan 6, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW4672 | FL | Primary |
Addresses
Primary practice location
1954 Howell Branch Rd
106
Winter Park, FL 32792-1041
Mailing address
1954 Howell Branch Rd
106
Winter Park, FL 32792-1041
Phone (407) 657-8555
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10745887 | Other | FL | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2024 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW4672 | FL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231200000000",
"number": "1053557587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1954 HOWELL BRANCH RD",
"address_2": "106",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327921041",
"telephone_number": "407-657-8555",
"fax_number": "407-657-5774"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1954 HOWELL BRANCH RD",
"address_2": "106",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327921041",
"telephone_number": "407-657-8555",
"fax_number": "407-657-5774"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUMLY",
"first_name": "SALLY",
"middle_name": "J",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-01-06",
"last_updated": "2009-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW4672",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "10745887",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winter Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.