Provider Demographics
NPI:1558575571
Name:KRUEGER, ROBERT (PHD, FICPP)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:PHD, FICPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 71 BOX 55B
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-9500
Mailing Address - Country:US
Mailing Address - Phone:505-758-3564
Mailing Address - Fax:
Practice Address - Street 1:HC 71 BOX 55B
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-9500
Practice Address - Country:US
Practice Address - Phone:505-758-3564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM281103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000N8651Medicaid