Provider Demographics
NPI:1043061039
Name:KRAEGER, BRUCE (CASAC-T)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:KRAEGER
Suffix:
Gender:M
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 WYNN RD APT 209
Mailing Address - Street 2:
Mailing Address - City:CONSTABLEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13325-2404
Mailing Address - Country:US
Mailing Address - Phone:315-405-7566
Mailing Address - Fax:
Practice Address - Street 1:500 WHITESBORO ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3015
Practice Address - Country:US
Practice Address - Phone:315-724-5168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38079101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)