Provider Demographics
NPI:1093986853
Name:KRUSE, GERARD ADAM (LMSW)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:ADAM
Last Name:KRUSE
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 1:17337 CHEVEYO CV
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-7461
Mailing Address - Country:US
Mailing Address - Phone:501-470-8445
Mailing Address - Fax:
Practice Address - Street 1:1400 N SEMORAN BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3536
Practice Address - Country:US
Practice Address - Phone:917-301-0727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.09927314104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker