Provider Demographics
NPI:1477930550
Name:CROTTY, DANIELLE (MS, CST)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:CROTTY
Suffix:
Gender:F
Credentials:MS, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3837 QUEEN CREST AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-3926
Mailing Address - Country:US
Mailing Address - Phone:513-519-0840
Mailing Address - Fax:
Practice Address - Street 1:3665 ERIE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-1982
Practice Address - Country:US
Practice Address - Phone:513-438-0448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF.2000122106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY610661458OtherTAX ID