Provider Demographics
NPI:1871049551
Name:CROSBY, EILEEN MARIE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:MARIE
Last Name:CROSBY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8633 EDINBROOK XING APT 155
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-4010
Mailing Address - Country:US
Mailing Address - Phone:651-283-0964
Mailing Address - Fax:
Practice Address - Street 1:10077 DOGWOOD ST NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-5286
Practice Address - Country:US
Practice Address - Phone:651-777-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000010815104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker