Provider Demographics
NPI:1578695078
Name:CROWLEY, PAUL MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:CROWLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 POND ST
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-3454
Mailing Address - Country:US
Mailing Address - Phone:781-631-1426
Mailing Address - Fax:
Practice Address - Street 1:46 PEARL ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4041
Practice Address - Country:US
Practice Address - Phone:617-492-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPR 223103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist