Provider Demographics
NPI:1609014869
Name:CROSE, ELIZABETH SONG (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SONG
Last Name:CROSE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:SONG
Other - Last Name:STILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1703
Mailing Address - Country:US
Mailing Address - Phone:856-617-4544
Mailing Address - Fax:
Practice Address - Street 1:32 S MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2455
Practice Address - Country:US
Practice Address - Phone:856-617-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NJ44SL06513100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical