Provider Demographics
NPI:1184712176
Name:CROEN, JUDITH DEBORAH (LCSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:DEBORAH
Last Name:CROEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:DEBORAH
Other - Last Name:KATAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:P.O. BOX 172
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-9203
Mailing Address - Country:US
Mailing Address - Phone:203-274-4284
Mailing Address - Fax:
Practice Address - Street 1:3 WEST END AVENUE
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-9203
Practice Address - Country:US
Practice Address - Phone:203-274-4284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0042691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD80821Medicare UPIN
800003783Medicare PIN