Provider Demographics
NPI:1215990262
Name:CROWLEY, KATHY (LCSW)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:CROWLEY
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 1:13242 N 28TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-6002
Mailing Address - Country:US
Mailing Address - Phone:602-573-6621
Mailing Address - Fax:623-487-9631
Practice Address - Street 1:17215 N 72ND DR
Practice Address - Street 2:SUITE D140
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8558
Practice Address - Country:US
Practice Address - Phone:602-573-6621
Practice Address - Fax:623-487-9631
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 06251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ791899Medicaid