Provider Demographics
NPI:1447401476
Name:CROSDALE, SERENA MARIA
Entity Type:Individual
Prefix:MS
First Name:SERENA
Middle Name:MARIA
Last Name:CROSDALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WHITING ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3184
Mailing Address - Country:US
Mailing Address - Phone:860-223-2778
Mailing Address - Fax:860-223-3297
Practice Address - Street 1:125 WHITING ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-3184
Practice Address - Country:US
Practice Address - Phone:860-223-2778
Practice Address - Fax:860-223-3297
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0088531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical