Provider Demographics
NPI:1538394903
Name:CROWLEY, JUDITH ANTIN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANTIN
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:PO BOX 14023
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-4023
Mailing Address - Country:US
Mailing Address - Phone:850-567-0766
Mailing Address - Fax:850-201-8830
Practice Address - Street 1:2510 MICCOSUKEE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5473
Practice Address - Country:US
Practice Address - Phone:850-567-0766
Practice Address - Fax:850-201-8830
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 37321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical