Provider Demographics
NPI:1194762096
Name:CRONIN, CHRISTINE ANN (LCSW-C)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:CRONIN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 GWYNNBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1409
Mailing Address - Country:US
Mailing Address - Phone:410-843-7440
Mailing Address - Fax:140-664-0115
Practice Address - Street 1:3506 GWYNNBROOK AVE
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-1409
Practice Address - Country:US
Practice Address - Phone:410-843-7440
Practice Address - Fax:410-664-0115
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD076541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH103F607Medicare PIN