Provider Demographics
NPI:1255462198
Name:CROSBY, MICHAEL CHARLES (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:CROSBY
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:CHARLES
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SOCIAL WORKER
Mailing Address - Street 1:3220 202ND ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1018
Mailing Address - Country:US
Mailing Address - Phone:718-279-0216
Mailing Address - Fax:
Practice Address - Street 1:6200 REV. JOSEPH H MAY DRIVE
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692
Practice Address - Country:US
Practice Address - Phone:718-318-0032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2009-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY57923171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5792317Medicare ID - Type UnspecifiedLCSW-R