Provider Demographics
NPI:1902857576
Name:KRUK, SUSAN (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KRUK
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 1:2061 FAIRVIEW AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3953
Mailing Address - Country:US
Mailing Address - Phone:610-923-0411
Mailing Address - Fax:610-923-5188
Practice Address - Street 1:2061 FAIRVIEW AVE
Practice Address - Street 2:2ND. FLOOR
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3953
Practice Address - Country:US
Practice Address - Phone:610-923-0411
Practice Address - Fax:610-923-5188
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW007328L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical