Provider Demographics
NPI:1356479471
Name:CROWLEY, WALTER J (LICSW)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:J
Last Name:CROWLEY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CAUSEWAY ST
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-2318
Mailing Address - Country:US
Mailing Address - Phone:508-359-2584
Mailing Address - Fax:
Practice Address - Street 1:21 CAUSEWAY ST
Practice Address - Street 2:
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-2318
Practice Address - Country:US
Practice Address - Phone:508-359-2584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1035541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical