Healthcare Provider Details

I. General information

NPI: 1952938136
Provider Name (Legal Business Name): DOUGLAS S CROOK DNP, RN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

872 MASSACHUSETTS AVE UNIT 2
CAMBRIDGE MA
02139-3073
US

IV. Provider business mailing address

872 MASSACHUSETTS AVE UNIT 2
CAMBRIDGE MA
02139-3073
US

V. Phone/Fax

Practice location:
  • Phone: 617-395-5806
  • Fax:
Mailing address:
  • Phone: 617-395-5806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2264271
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: