Provider Demographics
NPI:1235343021
Name:MRUK, KAREN LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:MRUK
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 1:74 2ND PL APT 5B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4143
Mailing Address - Country:US
Mailing Address - Phone:718-643-4828
Mailing Address - Fax:
Practice Address - Street 1:24 E 12TH ST RM 505
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4560
Practice Address - Country:US
Practice Address - Phone:212-337-1138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR050677-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN050677Medicare ID - Type Unspecified