Provider Demographics
NPI:1487131678
Name:ELLIS-CRNKOVICH, CARRIE (MSW,LICSW)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:ELLIS-CRNKOVICH
Suffix:
Gender:F
Credentials:MSW,LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 MURPHY AVE
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2550
Mailing Address - Country:US
Mailing Address - Phone:817-899-8060
Mailing Address - Fax:
Practice Address - Street 1:3920 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5343
Practice Address - Country:US
Practice Address - Phone:304-748-3769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX538161041C0700X
WVDP009452501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical