MEDICARE: KEAH CROSBY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	18661	MD

General Provider Information

NPI Number	:	1306175765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEAH CROSBY

Provider Business Mailing Address
First Line	:	PO BOX 32633
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21282-2633
Country	:	US
Telephone Number	:	410-627-2063
Fax Number	:

Provider Business Practice Location Address
First Line	:	2420 ARUNAH AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21216-4823
Country	:	US
Telephone Number	:	410-627-2063
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2009
Last Update Date	:	08/05/2014

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Directions to “ KEAH CROSBY ” Practice Location

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