Provider Demographics
NPI:1689816662
Name:KRUEGER, ANITA A (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:A
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:ANITA
Other - Middle Name:ANN
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202
Mailing Address - Country:US
Mailing Address - Phone:716-898-1671
Mailing Address - Fax:716-898-1311
Practice Address - Street 1:1010 MAIN ST.
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202
Practice Address - Country:US
Practice Address - Phone:716-898-1671
Practice Address - Fax:716-898-1311
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083752-1104100000X
NY0837521104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00838757Medicaid