Provider Demographics
NPI:1609819309
Name:CROMER, MARY AGNES (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:AGNES
Last Name:CROMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:320 SILVERBERRY CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5547
Mailing Address - Country:US
Mailing Address - Phone:919-636-0799
Mailing Address - Fax:
Practice Address - Street 1:3725 NATIONAL DR
Practice Address - Street 2:SUITE 220
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4066
Practice Address - Country:US
Practice Address - Phone:919-781-8370
Practice Address - Fax:919-781-2266
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0047551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106030Medicaid
NC6106030Medicaid