Provider Demographics
NPI:1477323939
Name:CROKE, TANYA REBEKAH (LISCW)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:REBEKAH
Last Name:CROKE
Suffix:
Gender:F
Credentials:LISCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:TUNBRIDGE
Mailing Address - State:VT
Mailing Address - Zip Code:05077-0072
Mailing Address - Country:US
Mailing Address - Phone:802-565-0149
Mailing Address - Fax:802-728-4197
Practice Address - Street 1:1740 LOWER PLN
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:VT
Practice Address - Zip Code:05033-8934
Practice Address - Country:US
Practice Address - Phone:802-728-4466
Practice Address - Fax:802-728-4197
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.0135673104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker