Provider Demographics
NPI:1225564149
Name:CROSWELL, VICTORIA ANNE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANNE
Last Name:CROSWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 NORTH ST # 83
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06783-9992
Mailing Address - Country:US
Mailing Address - Phone:781-534-4795
Mailing Address - Fax:
Practice Address - Street 1:26 NORTH ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:CT
Practice Address - Zip Code:06783-9992
Practice Address - Country:US
Practice Address - Phone:781-534-4795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 101YP2500X, 101YS0200X, 1041C0700X, 1041S0200X, 104100000X
CT116511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool