Healthcare Provider Details

I. General information

NPI: 1215990262
Provider Name (Legal Business Name): KATHY CROWLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 E GREENWAY RD STE 100
PHOENIX AZ
85032-4805
US

IV. Provider business mailing address

13242 N 28TH PL
PHOENIX AZ
85032-6002
US

V. Phone/Fax

Practice location:
  • Phone: 602-573-6621
  • Fax:
Mailing address:
  • Phone: 602-573-6621
  • Fax: 623-487-9631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 0625
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: