Provider Demographics
NPI:1376845867
Name:CROWE, STEPHANIE SUZANNE (MS)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:SUZANNE
Last Name:CROWE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 CECIL WEBB PL
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-8336
Mailing Address - Country:US
Mailing Address - Phone:386-842-5555
Mailing Address - Fax:
Practice Address - Street 1:1813 CECIL WEBB PL
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060-8336
Practice Address - Country:US
Practice Address - Phone:386-842-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health