Provider Demographics
NPI:1962565515
Name:CROWLEY, JOSEPH J (PHD, LCP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:CROWLEY
Suffix:
Gender:M
Credentials:PHD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4247
Mailing Address - Country:US
Mailing Address - Phone:804-323-1464
Mailing Address - Fax:
Practice Address - Street 1:6714 PATTERSON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3432
Practice Address - Country:US
Practice Address - Phone:804-285-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA329103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA68000069Medicare PIN
VAP00061877Medicare PIN