Provider Demographics
NPI:1174155543
Name:GIROUARD-CRUSH, AMY S (LICSW)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:S
Last Name:GIROUARD-CRUSH
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 1:22 N CURTISVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5906
Mailing Address - Country:US
Mailing Address - Phone:603-738-0887
Mailing Address - Fax:
Practice Address - Street 1:22 N CURTISVILLE RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5906
Practice Address - Country:US
Practice Address - Phone:603-738-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1195OtherLICENSE