Healthcare Provider Details

I. General information

NPI: 1013131267
Provider Name (Legal Business Name): DR. MARIA B. CRUSE APMG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 NORTH ACADIA ROAD SUITE 201
THIBODAUX LA
70301
US

IV. Provider business mailing address

604 N ACADIA RD SUITE 201
THIBODAUX LA
70301-4847
US

V. Phone/Fax

Practice location:
  • Phone: 985-493-9304
  • Fax: 985-493-9305
Mailing address:
  • Phone: 985-493-9304
  • Fax: 985-493-9305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number09188R
License Number StateLA

VIII. Authorized Official

Name: DR. MARIA B. CRUSE
Title or Position: OWNER
Credential: MD
Phone: 985-493-9304