Healthcare Provider Details

I. General information

NPI: 1659561827
Provider Name (Legal Business Name): KRISTEN C. CROWLEY LICSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 HIGH WATCH RD
EFFINGHAM NH
03882-8336
US

IV. Provider business mailing address

244 HIGH WATCH RD
EFFINGHAM NH
03882-8336
US

V. Phone/Fax

Practice location:
  • Phone: 207-337-4147
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC12699
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1958
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: