Provider Demographics
NPI:1740576198
Name:CROWE, JAY PATRICK (LISW)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:PATRICK
Last Name:CROWE
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 RANCHITOS RD
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-9580
Mailing Address - Country:US
Mailing Address - Phone:505-934-1248
Mailing Address - Fax:
Practice Address - Street 1:106 RANCHITOS RD
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-9580
Practice Address - Country:US
Practice Address - Phone:505-934-1248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-00421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical