Provider Demographics
NPI:1568075034
Name:CROCKETT, ALLISON FRANCES
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:FRANCES
Last Name:CROCKETT
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 1:30 HUNTER LANE
Mailing Address - Street 2:
Mailing Address - City:CAMP HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:17011
Mailing Address - Country:US
Mailing Address - Phone:717-761-2633
Mailing Address - Fax:717-995-5871
Practice Address - Street 1:744 WOLCOTT STREET
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716
Practice Address - Country:US
Practice Address - Phone:203-879-5853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2023-02-22
Deactivation Date:2022-10-12
Deactivation Code:
Reactivation Date:2023-02-20
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 171M00000X, 376K00000X
CT197913163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No376K00000XNursing Service Related ProvidersNurse's Aide