Healthcare Provider Details

I. General information

NPI: 1962963330
Provider Name (Legal Business Name): LAURA M CROUCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HAMILTON AVE
AUBURN NY
13021-5028
US

IV. Provider business mailing address

101 HAMILTON AVE
AUBURN NY
13021-5028
US

V. Phone/Fax

Practice location:
  • Phone: 315-253-5383
  • Fax: 315-253-7278
Mailing address:
  • Phone: 315-253-5383
  • Fax: 315-253-7278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number083694-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: