Provider Demographics
NPI:1578868576
Name:CROTTY, ELLEN KATHRYN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:KATHRYN
Last Name:CROTTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 79TH ST APT 1H
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-2608
Mailing Address - Country:US
Mailing Address - Phone:347-730-4565
Mailing Address - Fax:
Practice Address - Street 1:3420 79TH ST APT 1H
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-2608
Practice Address - Country:US
Practice Address - Phone:347-730-4565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0879321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical