MEDICARE: ANTOINE 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	171W00000X	Contractor
2	103TC0700X	Clinical Psychologist	PSY1001557	DC
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1518379106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINE CROSBY

Provider Business Mailing Address
First Line	:	1200 G ST NW STE 800
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20005-6705
Country	:	US
Telephone Number	:	202-770-7067
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 JENIFER JENIFER NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010
Country	:	US
Telephone Number	:	202-244-2221
Fax Number	:

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

Provider Enumeration Date	:	05/29/2014
Last Update Date	:	03/24/2026

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Directions to “ ANTOINE CROSBY ” Practice Location

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