Provider Demographics
NPI:1184294456
Name:CROWELL, JASON (LADC/LMSW)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:CROWELL
Suffix:
Gender:M
Credentials:LADC/LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 DIXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3456
Mailing Address - Country:US
Mailing Address - Phone:475-224-9229
Mailing Address - Fax:203-503-3442
Practice Address - Street 1:226 DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3456
Practice Address - Country:US
Practice Address - Phone:475-224-9229
Practice Address - Fax:203-503-3442
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001414101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001414Medicaid
CT008001325Medicaid
CT001414Medicaid
CT008103002Medicaid
CT008022622Medicaid