Provider Demographics
NPI:1770513160
Name:ITLE CROSBY, BERNADETTE (LCSW)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:ITLE CROSBY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3402
Mailing Address - Country:US
Mailing Address - Phone:570-433-0249
Mailing Address - Fax:
Practice Address - Street 1:811 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3402
Practice Address - Country:US
Practice Address - Phone:570-433-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0152981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100366NKAMedicare ID - Type UnspecifiedLCSW