MEDICARE: WAYNE ERNEST CROSSMAN 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	000486	CT

General Provider Information

NPI Number	:	1518060201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE ERNEST CROSSMAN LCSW

Provider Business Mailing Address
First Line	:	10 DEFOREST DR
Second Line	:
City	:	NORTH BRANFORD
State	:	CT
Zip	:	06471-1258
Country	:	US
Telephone Number	:	203-468-2998
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 DEFOREST DR
Second Line	:
City	:	NORTH BRANFORD
State	:	CT
Zip	:	06471-1258
Country	:	US
Telephone Number	:	203-468-2998
Fax Number	:

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	04/27/2026

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