Provider Demographics
NPI:1396025318
Name:CROCCO, KATECHEN ELIZABET (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATECHEN
Middle Name:ELIZABET
Last Name:CROCCO
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 1:1073 MAIN ST
Mailing Address - Street 2:SUITE: 214
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3513
Mailing Address - Country:US
Mailing Address - Phone:845-235-5102
Mailing Address - Fax:
Practice Address - Street 1:1073 MAIN ST
Practice Address - Street 2:SUITE: 214
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-3513
Practice Address - Country:US
Practice Address - Phone:845-235-5102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081812-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical