MEDICARE: MRS. EILEEN MARIE CROSBY LICSW

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	104100000X	Social Worker	LSW0000010815	TN

General Provider Information

NPI Number	:	1871049551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EILEEN MARIE CROSBY LICSW

Provider Business Mailing Address
First Line	:	8633 EDINBROOK XING APT 155
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-4010
Country	:	US
Telephone Number	:	651-283-0964
Fax Number	:

Provider Business Practice Location Address
First Line	:	10077 DOGWOOD ST NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-5286
Country	:	US
Telephone Number	:	651-777-5222
Fax Number	:

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

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	10/12/2022

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