Provider Demographics
NPI:1467934539
Name:CROWLEY, SUSAN MARY (LICSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SNOW ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3412
Mailing Address - Country:US
Mailing Address - Phone:617-779-8128
Mailing Address - Fax:
Practice Address - Street 1:WABAN HEALTH CENTER
Practice Address - Street 2:20 KINMONTH ROAD
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02468
Practice Address - Country:US
Practice Address - Phone:617-332-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1107601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical