Healthcare Provider Details

I. General information

NPI: 1518372358
Provider Name (Legal Business Name): JOHN CROUCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 CLIPPER RD
BALTIMORE MD
21211-1404
US

IV. Provider business mailing address

3640 CLIPPER RD
BALTIMORE MD
21211-1404
US

V. Phone/Fax

Practice location:
  • Phone: 410-952-6166
  • Fax:
Mailing address:
  • Phone: 410-952-6166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW131370
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number26134
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH001806
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: