Provider Demographics
NPI:1760473441
Name:KRULEWITZ, JUDITH E (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:E
Last Name:KRULEWITZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 STONY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-8019
Mailing Address - Country:US
Mailing Address - Phone:617-818-2159
Mailing Address - Fax:
Practice Address - Street 1:545 CONCORD AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1125
Practice Address - Country:US
Practice Address - Phone:617-818-2159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3949-PY103TA0400X, 103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1899309Medicaid
MA135532000OtherMAGELLAN BEHAVIORAL HEALT
MAW03932OtherBLUE CROSS BLUE SHIELD
MAW03932Medicare ID - Type UnspecifiedMEDICARE