Provider Demographics
NPI:1568586832
Name:CROUT, JOANNE (LISW, LCSW)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:CROUT
Suffix:
Gender:F
Credentials:LISW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 CONTRERAS PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-2551
Mailing Address - Country:US
Mailing Address - Phone:505-328-7384
Mailing Address - Fax:505-328-7384
Practice Address - Street 1:1441 S SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4037
Practice Address - Country:US
Practice Address - Phone:505-982-8870
Practice Address - Fax:505-982-8870
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-069521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM47572531Medicaid