Provider Demographics
NPI:1275584005
Name:KATHY CROWLEY LCSW LLC
Entity Type:Organization
Organization Name:KATHY CROWLEY LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:602-573-6621
Mailing Address - Street 1:13242 N 28TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-6002
Mailing Address - Country:US
Mailing Address - Phone:602-573-6621
Mailing Address - Fax:623-487-9631
Practice Address - Street 1:17215 N 72ND DR
Practice Address - Street 2:SUITE D140
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8558
Practice Address - Country:US
Practice Address - Phone:602-573-6621
Practice Address - Fax:623-487-9631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 06251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLCSW 0625OtherSOCIAL WORK LICENSE
1215990262OtherPERSONAL NPI