Provider Demographics
NPI:1740216100
Name:CROSBY, CAROL B (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:B
Last Name:CROSBY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GAIA LN
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1649
Mailing Address - Country:US
Mailing Address - Phone:207-839-9608
Mailing Address - Fax:207-839-9608
Practice Address - Street 1:6 GAIA LN
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1649
Practice Address - Country:US
Practice Address - Phone:207-839-9608
Practice Address - Fax:207-839-9608
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC33761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM3782Medicare ID - Type Unspecified