Healthcare Provider Details

I. General information

NPI: 1962767509
Provider Name (Legal Business Name): ELIZABETH MCCROSKEY LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 UNION ST STE B1
NEWARK OH
43055-3998
US

IV. Provider business mailing address

3540 HANKINSON RD
GRANVILLE OH
43023-9706
US

V. Phone/Fax

Practice location:
  • Phone: 866-534-2639
  • Fax: 800-480-7578
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1200829
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: