Provider Demographics
NPI:1659867521
Name:CROSBY, MARIRHETTA L (MS, LIMFT, LPCC)
Entity Type:Individual
Prefix:
First Name:MARIRHETTA
Middle Name:L
Last Name:CROSBY
Suffix:
Gender:F
Credentials:MS, LIMFT, LPCC
Other - Prefix:
Other - First Name:MARIRHETTA
Other - Middle Name:L
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LIMFT, LPCC
Mailing Address - Street 1:3971 ARDMORE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2519
Mailing Address - Country:US
Mailing Address - Phone:216-903-2291
Mailing Address - Fax:
Practice Address - Street 1:3971 ARDMORE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44121-2519
Practice Address - Country:US
Practice Address - Phone:216-903-2291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2404088101Y00000X, 101YM0800X, 102L00000X
OHF.2400400103TP2701X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0376399Medicaid