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General NPI Number Information
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NPI Number | 1780779686
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Entity Type | Individual
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Provider Name | PAUL TIMOTHY CROSBY LICSW MSW
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 66 CLIFTON AVENUE
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City | MARBLEHEAD
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State | MA
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Zip | 01945
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Country | US
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Telephone | 781-631-8273
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Fax | 781-631-7264
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Provider Business Mailing Address
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Address Line | 26 GREENWOOD RD
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City | PEABODY
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State | MA
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Zip | 01960
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Country | US
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Telephone | 978-532-6947
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Fax |
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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 | SW1028281
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License Number State | MA
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