Provider Demographics
NPI:1821333246
Name:KRUTZKE, JAMES (MA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:KRUTZKE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WHITE HORSE PIKE
Mailing Address - Street 2:SUITE 1-B
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1246
Mailing Address - Country:US
Mailing Address - Phone:856-672-1900
Mailing Address - Fax:856-672-9019
Practice Address - Street 1:6 WHITE HORSE PIKE
Practice Address - Street 2:SUITE 1-B
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1246
Practice Address - Country:US
Practice Address - Phone:856-672-1900
Practice Address - Fax:856-672-9019
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00445500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional