Provider Demographics
NPI:1609802651
Name:CROUCH, W MICHAEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:W
Middle Name:MICHAEL
Last Name:CROUCH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 SUMMER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5546
Mailing Address - Country:US
Mailing Address - Phone:203-961-1152
Mailing Address - Fax:203-357-9030
Practice Address - Street 1:999 SUMMER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5546
Practice Address - Country:US
Practice Address - Phone:203-961-1152
Practice Address - Fax:203-357-9030
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0029251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140002925CT02OtherANTHEM BEHAVORIAL HEALTH
CT183922OtherMHN PROVIDER NUMBER
CT140002925CT02OtherANTHEM BEHAVORIAL HEALTH