Provider Demographics
NPI:1083939920
Name:KRAUSE, JEREMY VINCENT (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:VINCENT
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ALPINE PL APT 214
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14225-3979
Mailing Address - Country:US
Mailing Address - Phone:617-869-0527
Mailing Address - Fax:
Practice Address - Street 1:30 ALPINE PL APT 214
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14225-3979
Practice Address - Country:US
Practice Address - Phone:617-869-0527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-04
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086083104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty