Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS006949L | PA |
Y | 103TC0700X | Clinical Psychologist | PS006949L | PA |
N | 103TC1900X | Counseling Psychologist | PS006949L | PA |
NPI | 1003147042 |
---|---|
Provider Name | Ms. Elaine Renee Crouse |
First Address | Phila, PA 19130-4122 |
Second Address | Phila, PA 19130-4122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2010 |
Last Update Date | 14/01/2010 |