Provider Demographics
NPI:1962711101
Name:CROUGH, MEGHAN (LMFT)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:CROUGH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2700
Mailing Address - Country:US
Mailing Address - Phone:585-485-9999
Mailing Address - Fax:
Practice Address - Street 1:325 PARK AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2700
Practice Address - Country:US
Practice Address - Phone:585-485-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP82139106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01079267Medicaid
BA1047OtherGRP MEDICARE #
NY02994838OtherGRP MCD #
1235184235OtherGRP NPI