Provider Demographics
NPI:1801884069
Name:CROWLEY, THERRESA BLOHM (LCSW)
Entity type:Individual
Prefix:MS
First Name:THERRESA
Middle Name:BLOHM
Last Name:CROWLEY
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 1:15 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-1912
Mailing Address - Country:US
Mailing Address - Phone:631-924-2321
Mailing Address - Fax:
Practice Address - Street 1:565 ROUTE 25A
Practice Address - Street 2:SUITE 203
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2663
Practice Address - Country:US
Practice Address - Phone:631-924-2321
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0150071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMEDICAREN2961Medicare ID - Type UnspecifiedSOCIAL WORK