Provider Demographics
NPI:1689004335
Name:CREVOLA, AMY RUTH (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RUTH
Last Name:CREVOLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 NW SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1530
Mailing Address - Country:US
Mailing Address - Phone:541-714-3640
Mailing Address - Fax:541-981-5069
Practice Address - Street 1:969 NW SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1530
Practice Address - Country:US
Practice Address - Phone:541-714-3640
Practice Address - Fax:541-981-5069
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-16
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL80491041C0700X, 174H00000X, 101YM0800X
ORA3701101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174H00000XOther Service ProvidersHealth Educator