Provider Demographics
NPI:1376521195
Name:CROUSE-NOVAK, MARY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:CROUSE-NOVAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 MARKET ST
Mailing Address - Street 2:SUITE 223
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-6385
Mailing Address - Country:US
Mailing Address - Phone:570-505-1202
Mailing Address - Fax:570-651-9250
Practice Address - Street 1:460 MARKET ST
Practice Address - Street 2:SUITE 223
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6385
Practice Address - Country:US
Practice Address - Phone:570-505-1202
Practice Address - Fax:570-651-9250
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW-012345101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA162951OtherVALUE OPTIONS
PA2013061OtherCIGNA BEHAVIORAL HEALTH
7466214OtherAETNA
101561599OtherUNITED BEHAVIORAL HEALTH
828889OtherFIRST PRIORITY HEALTH
000178272OtherHIGHMARK
PA2013061OtherCIGNA BEHAVIORAL HEALTH
828889OtherFIRST PRIORITY HEALTH
PAP35322Medicare UPIN