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Certified Provider Details:
| PROVIDER NUMBER: | 490038 |
| AGENCY NAME: | WVU Dept. of B M & P |
| CONTACT NAME: | Kerri W. Crosby |
| ADDRESS: | 930 Chestnut Ridge Road |
| CITY: | Morgantown |
| STATE: | WV |
| ZIP: | 26505 |
| PHONE: | |
| WEB SITE: | www.hsc.wvu.edu/som/bemed |
| EMAIL ADDRESS: | kcrosby@hsc.wvu.edu |
| BSW/MSW NAME: | Eric Rankin, Ph.D |
| DUE TO RECERTIFY DATE: | 7/1/2010 |
| COMMENTS: |