Provider Demographics
NPI:1396860490
Name:CROWELL, MIMI (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIMI
Middle Name:
Last Name:CROWELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 5TH AVE APT 6F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8809
Mailing Address - Country:US
Mailing Address - Phone:212-460-8535
Mailing Address - Fax:212-260-5864
Practice Address - Street 1:80 5TH AVE RM 902
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8018
Practice Address - Country:US
Practice Address - Phone:212-989-8492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR016382-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical