Provider Demographics
NPI:1134762420
Name:CROWTHER, QUINCY CECILIA (LBS)
Entity type:Individual
Prefix:
First Name:QUINCY
Middle Name:CECILIA
Last Name:CROWTHER
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 DESTINY WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1611
Mailing Address - Country:US
Mailing Address - Phone:267-217-3585
Mailing Address - Fax:267-657-1341
Practice Address - Street 1:117 DESTINY WAY
Practice Address - Street 2:
Practice Address - City:NORTH WHALES
Practice Address - State:PA
Practice Address - Zip Code:19454
Practice Address - Country:US
Practice Address - Phone:267-217-3585
Practice Address - Fax:267-657-1341
Is Sole Proprietor?:No
Enumeration Date:2019-10-20
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA15313225A00000X
PABH005851103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103800593-0001Medicaid
PA1036984710002Medicaid