Provider Demographics
NPI:1518372358
Name:CROUCH, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CROUCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 CLIPPER RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1404
Mailing Address - Country:US
Mailing Address - Phone:410-952-6166
Mailing Address - Fax:
Practice Address - Street 1:3640 CLIPPER RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1404
Practice Address - Country:US
Practice Address - Phone:410-952-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001806103K00000X
PASW131370104100000X
MD26134104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst