Provider Demographics
NPI:1376774455
Name:KRUSCHEN, MARNIE
Entity Type:Individual
Prefix:
First Name:MARNIE
Middle Name:
Last Name:KRUSCHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 465
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91376-0465
Mailing Address - Country:US
Mailing Address - Phone:818-312-4554
Mailing Address - Fax:
Practice Address - Street 1:1911 WILLIAMS DRIVE
Practice Address - Street 2:SUITE NUMBER 200
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036
Practice Address - Country:US
Practice Address - Phone:805-981-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool