Healthcare Provider Details

I. General information

NPI: 1548076649
Provider Name (Legal Business Name): KERRI P CROUSSET LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2439 E DEL WEBB BLVD
SUN CITY CENTER FL
33573-6972
US

IV. Provider business mailing address

PO BOX 7403
SUN CITY FL
33586-7403
US

V. Phone/Fax

Practice location:
  • Phone: 519-520-4593
  • Fax:
Mailing address:
  • Phone: 519-520-4593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: