Provider Demographics
NPI:1902437031
Name:CROWTHER MAYA, TRACEY (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:CROWTHER MAYA
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 MADISON AVE RM 600
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6779
Mailing Address - Country:US
Mailing Address - Phone:917-216-7787
Mailing Address - Fax:
Practice Address - Street 1:148 MADISON AVE RM 600
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6779
Practice Address - Country:US
Practice Address - Phone:917-216-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010057101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health