Provider Demographics
NPI:1003147042
Name:CROUSE, ELAINE RENEE (MA)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:RENEE
Last Name:CROUSE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 SPRING GARDEN ST
Mailing Address - Street 2:EMPOWERMENT RESOURCE ASSOCIATES-2ND FLOOR
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-4122
Mailing Address - Country:US
Mailing Address - Phone:215-564-0680
Mailing Address - Fax:
Practice Address - Street 1:1822 SPRING GARDEN ST
Practice Address - Street 2:EMPOWERMENT RESOURCE ASSOCIATES-2ND FLOOR
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19130-4122
Practice Address - Country:US
Practice Address - Phone:215-564-0680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006949L103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling