Provider Demographics
NPI:1124223383
Name:CROFOOT, MARIE (MSW)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:CROFOOT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 GOODWIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:275 HOSPITAL PKWY
Practice Address - Street 2:SUITE 865
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1106
Practice Address - Country:US
Practice Address - Phone:408-363-4568
Practice Address - Fax:408-972-6149
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker