Provider Demographics
NPI:1295070373
Name:CROMER, MARIA IRINA (LISW)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:IRINA
Last Name:CROMER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:IRINA
Other - Last Name:JONAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:449 WOODHOUSE LOOP
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7781
Mailing Address - Country:US
Mailing Address - Phone:803-216-0850
Mailing Address - Fax:803-216-0420
Practice Address - Street 1:409 EVELYN DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5212
Practice Address - Country:US
Practice Address - Phone:803-216-0850
Practice Address - Fax:803-216-0420
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC95401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical