Provider Demographics
NPI:1558880237
Name:KROUSE, ANJELICA
Entity Type:Individual
Prefix:
First Name:ANJELICA
Middle Name:
Last Name:KROUSE
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 1:8 JESSE CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-5808
Mailing Address - Country:US
Mailing Address - Phone:845-741-2776
Mailing Address - Fax:
Practice Address - Street 1:530 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-2008
Practice Address - Country:US
Practice Address - Phone:518-346-1284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102316104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker