Provider Demographics
NPI:1447693817
Name:CRESCENT THERAPY AND ASSESSMENT SERVICES, LLC
Entity type:Organization
Organization Name:CRESCENT THERAPY AND ASSESSMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAENA
Authorized Official - Middle Name:ROSHANA
Authorized Official - Last Name:BAPTISTE-BOLES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-230-0029
Mailing Address - Street 1:2810 SAN JACINTO CIR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6109
Mailing Address - Country:US
Mailing Address - Phone:321-230-0029
Mailing Address - Fax:321-233-0272
Practice Address - Street 1:160 INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5056
Practice Address - Country:US
Practice Address - Phone:407-494-4388
Practice Address - Fax:321-233-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8557251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health