Healthcare Provider Details

I. General information

NPI: 1699113282
Provider Name (Legal Business Name): JEANNE H. CROY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 MAIN ST STE 304
SPRINGVALE ME
04083-1872
US

IV. Provider business mailing address

PO BOX 1081
ALFRED ME
04002-1081
US

V. Phone/Fax

Practice location:
  • Phone: 207-502-0056
  • Fax:
Mailing address:
  • Phone: 207-502-0056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC14181
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: