Healthcare Provider Details

I. General information

NPI: 1164349510
Provider Name (Legal Business Name): DANIEL JAY CROTTY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 W POLK ST
CHICAGO IL
60605-2000
US

IV. Provider business mailing address

600 N MCCLURG CT APT 3207
CHICAGO IL
60611-4844
US

V. Phone/Fax

Practice location:
  • Phone: 914-714-9951
  • Fax:
Mailing address:
  • Phone: 914-714-9951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.118409
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: