Provider Demographics
NPI:1205368461
Name:KRULEWITCH, SAMUEL (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:KRULEWITCH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:KRULEWITCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1732 SE ASH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1526
Mailing Address - Country:US
Mailing Address - Phone:503-200-8350
Mailing Address - Fax:
Practice Address - Street 1:1732 SE ASH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1526
Practice Address - Country:US
Practice Address - Phone:503-200-8350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL111391041C0700X
372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No372600000XNursing Service Related ProvidersAdult Companion