Crockett Foundation Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

CROCKETT FOUNDATION INC

Practice address

401 SW 1St Ave Ste 102
Fort Lauderdale, FL 33301-2853

Phone

(754) 666-3928

NPI assigned

Jul 9, 2021

Organization subpart

No

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

Authorized official

Name

Ms. Regine Kanzki, MPH

Title

Vice President of Operations

Phone

(954) 822-9370

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1625788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625788800000",
    "number": "1184295123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 SW 1ST AVE STE 102",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333012853",
            "telephone_number": "754-666-3928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 SW 1ST AVE STE 102",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333012853",
            "telephone_number": "754-666-3928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROCKETT FOUNDATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-09",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "status": "A",
        "authorized_official_last_name": "KANZKI",
        "authorized_official_first_name": "REGINE",
        "authorized_official_title_or_position": "VICE PRESIDENT OF OPERATIONS",
        "authorized_official_telephone_number": "954-822-9370",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Viviana Crespo, MD
• Elissa Crist, LMFT
• Jack Joseph Cristiano Jr., PA-C
• Tanese Croasdale
• Nikolas Crocker
• Stephanie A Crofutt, LCSW
• Tabitha Crosno
• Brian J Cross, DO
• Peter W Cross, CRNA
• Crossroads Wellness Group, LLC

• Community/Behavioral Health Agency in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Community/Behavioral Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2021; 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.