Provider Demographics
NPI:1558147926
Name:CROCKER, MAREN
Entity Type:Individual
Prefix:
First Name:MAREN
Middle Name:
Last Name:CROCKER
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 1:8610 HIDDEN RIVER PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-1114
Mailing Address - Country:US
Mailing Address - Phone:813-481-9662
Mailing Address - Fax:813-704-2600
Practice Address - Street 1:8610 HIDDEN RIVER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-1114
Practice Address - Country:US
Practice Address - Phone:813-481-9662
Practice Address - Fax:813-704-2600
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician