Individual provider Active NPI

Andrea Crayden, MSW, LISW-S

  • Clinical Social Worker
  • Canton, OH
National Provider Identifier
1104206945
Registry record updated Jun 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I9649 Issued in OH
Practice address
733 Market Ave S
Canton, OH 44702-2165
Phone
(330) 489-4600
NPI assigned
Jun 7, 2015
Last updated
Jun 7, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X I9649 OH Primary

Addresses

Primary practice location

733 Market Ave S
Canton, OH 44702-2165

Mailing address

1414 W Easton Rd
Burbank, OH 44214-9580
Phone (330) 466-4647

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
I9649OHMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433635200000",
    "number": "1104206945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 W EASTON RD",
            "city": "BURBANK",
            "state": "OH",
            "postal_code": "442149580",
            "telephone_number": "330-466-4647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "733 MARKET AVE S",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447022165",
            "telephone_number": "330-489-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRAYDEN",
        "first_name": "ANDREA",
        "credential": "MSW, LISW-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-07",
        "last_updated": "2015-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I9649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.