Provider Demographics
NPI:1164562559
Name:KRIZEK, CLAUDETTE R (LCSW)
Entity Type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:R
Last Name:KRIZEK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13411 THOROUGHBRED DR
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-6247
Mailing Address - Country:US
Mailing Address - Phone:352-588-4676
Mailing Address - Fax:352-588-3106
Practice Address - Street 1:675 BILTMORE AVE
Practice Address - Street 2:STE G
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2527
Practice Address - Country:US
Practice Address - Phone:813-956-1598
Practice Address - Fax:828-254-5486
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW58771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1762OtherBLUE CROSS BLUE SHIELD NU