Provider Demographics
NPI:1649402991
Name:KRUTSKY, ANNA R (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:R
Last Name:KRUTSKY
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 1:1001 W BROADWAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5638
Mailing Address - Country:US
Mailing Address - Phone:505-325-0238
Mailing Address - Fax:
Practice Address - Street 1:1001 W BROADWAY
Practice Address - Street 2:SUITE D
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5638
Practice Address - Country:US
Practice Address - Phone:505-325-0238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-083021041C0700X
NMC-085091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM50876544Medicaid
NM1649402991OtherOPTUMHEALTH
NM1649402991OtherPRESBYTERIAN HEALTH PLAN
NM4902099OtherCIGNA BH
NM1649402991OtherBCBS OF NM
NM1649402991OtherAMERIGROUP
NM1649402991OtherNEW MEXICO HEALTH CONNECTIONS
NM1649402991OtherMOLINA HEALTHCARE