MEDICARE: BROCELYN L CROWLEY

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	104100000X	Social Worker	6801103565	MI

General Provider Information

NPI Number	:	1982275533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROCELYN L CROWLEY

Provider Business Mailing Address
First Line	:	247 SWEET MARTHA DR
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28115-7906
Country	:	US
Telephone Number	:	570-772-6020
Fax Number	:

Provider Business Practice Location Address
First Line	:	4211 OKEMOS RD STE 18
Second Line	:
City	:	OKEMOS
State	:	MI
Zip	:	48864-3287
Country	:	US
Telephone Number	:	313-444-3480
Fax Number	:

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

Provider Enumeration Date	:	07/06/2021
Last Update Date	:	07/06/2021

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Directions to “ BROCELYN L CROWLEY ” Practice Location

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