MEDICARE: MEGHAN CROWLEY BCBA

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1881095529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN CROWLEY BCBA

Provider Business Mailing Address
First Line	:	5694 MISSION CENTER RD
Second Line	:	SUITE 602 PMB 341
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4355
Country	:	US
Telephone Number	:	619-952-6295
Fax Number	:	619-220-0215

Provider Business Practice Location Address
First Line	:	7860 MISSION CENTER CT
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1329
Country	:	US
Telephone Number	:	619-952-6295
Fax Number	:	619-220-0215

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

Provider Enumeration Date	:	09/12/2014
Last Update Date	:	09/12/2014

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