MEDICARE: ROSEMARIE CRENSHAW LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC05757400	NJ

General Provider Information

NPI Number	:	1205204906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMARIE CRENSHAW LCSW

Provider Business Mailing Address
First Line	:	509 MAIN ST STE A
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-7402
Country	:	US
Telephone Number	:	732-693-1031
Fax Number	:	732-749-1623

Provider Business Practice Location Address
First Line	:	509 MAIN ST STE A
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-7402
Country	:	US
Telephone Number	:	732-723-7130
Fax Number	:	732-276-9896

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2015
Last Update Date	:	09/07/2022

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