Provider Demographics
NPI:1447529029
Name:CROWELL-MILLER, CHASSITY ANGELA (LICSW)
Entity type:Individual
Prefix:MRS
First Name:CHASSITY
Middle Name:ANGELA
Last Name:CROWELL-MILLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CHASSITY
Other - Middle Name:ANGELA
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:134 GATES AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1146
Mailing Address - Country:US
Mailing Address - Phone:413-561-0651
Mailing Address - Fax:
Practice Address - Street 1:134 GATES AVE
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1146
Practice Address - Country:US
Practice Address - Phone:413-561-0651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA413590104100000X
MA1041C0700X
MA1201111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker