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General NPI Number Information
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NPI Number | 1326080136
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Entity Type | Individual
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Provider Name | JEFFREY STEWART CROUCH LCSW-C
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 10632 LITTLE PATUXENT PKWY SUITE 313
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City | COLUMBIA
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State | MD
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Zip | 21044-3273
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Country | US
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Telephone | 443-538-1247
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Fax | 443-276-6640
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Provider Business Mailing Address
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Address Line | 10632 LITTLE PATUXENT PKWY SUITE 313
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City | COLUMBIA
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State | MD
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Zip | 21044-3273
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Country | US
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Telephone | 443-538-1247
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Fax | 410-740-2421
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 06143
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 06143
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License Number State | MD
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