Provider Demographics
NPI:1043271182
Name:CRUSH, DOUGLAS (PHD)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:CRUSH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1834
Mailing Address - Country:US
Mailing Address - Phone:330-759-2310
Mailing Address - Fax:
Practice Address - Street 1:1934 NILES CORTLAND RD NE
Practice Address - Street 2:STE B
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1055
Practice Address - Country:US
Practice Address - Phone:330-841-4032
Practice Address - Fax:330-841-4381
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2309103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3810004016OtherUNISYS
OH0332063Medicaid
OH1487790028OtherBWC WARREN OFFICE
OH1811041684OtherBWC HOWLAND OFFICE
11580809OtherCAQH
OH0332063Medicaid
OH1487790028OtherBWC WARREN OFFICE
OHCP12064Medicare PIN
OHCP12061Medicare PIN
OH1811041684OtherBWC HOWLAND OFFICE
OH3810004016OtherUNISYS