MEDICARE: MR. JEFFREY STEWART CROUCH LCSW-C

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	06143	MD
2	104100000X	Social Worker	06143	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326080136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY STEWART CROUCH LCSW-C

Provider Business Mailing Address
First Line	:	10632 LITTLE PATUXENT PKWY
Second Line	:	SUITE 313
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3273
Country	:	US
Telephone Number	:	443-538-1247
Fax Number	:	410-740-2421

Provider Business Practice Location Address
First Line	:	10632 LITTLE PATUXENT PKWY
Second Line	:	SUITE 313
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3273
Country	:	US
Telephone Number	:	443-538-1247
Fax Number	:	443-276-6640

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	01/23/2017

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Directions to “ MR. JEFFREY STEWART CROUCH LCSW-C” Practice Location

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