Provider Demographics
NPI:1588655674
Name:CROWLEY, JANET ANN (MA)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:ANN
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4944 LINDELL BLVD
Mailing Address - Street 2:APT 5E
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1534
Mailing Address - Country:US
Mailing Address - Phone:314-454-9416
Mailing Address - Fax:314-647-3605
Practice Address - Street 1:7700 CLAYTON RD
Practice Address - Street 2:SUITE 208
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1328
Practice Address - Country:US
Practice Address - Phone:314-647-3558
Practice Address - Fax:314-647-3605
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01383103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO110036OtherBLUE CROSS BLUE SHIELD
MO291856OtherMANAGED HEALTH NETWORK
MO21552Medicare ID - Type UnspecifiedPROVIDER NUMBER