MEDICARE: DR. SHANTEL DEANNA CROSBY PHD, LCSW

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	252267	KY

General Provider Information

NPI Number	:	1689938532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANTEL DEANNA CROSBY PHD, LCSW

Provider Business Mailing Address
First Line	:	11700 WASHINGTON GREEN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40229-5533
Country	:	US
Telephone Number	:	502-208-8496
Fax Number	:

Provider Business Practice Location Address
First Line	:	11700 WASHINGTON GREEN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40229-5533
Country	:	US
Telephone Number	:	502-208-8496
Fax Number	:

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

Provider Enumeration Date	:	06/26/2012
Last Update Date	:	01/02/2022

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