Provider Demographics
NPI:1972220747
Name:KRAKUS, SARAH (LAC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:KRAKUS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 LAFAYETTE CIR
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2196
Mailing Address - Country:US
Mailing Address - Phone:347-241-3437
Mailing Address - Fax:
Practice Address - Street 1:73 LAFAYETTE CIR
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2196
Practice Address - Country:US
Practice Address - Phone:201-383-6236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00642400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJYKZ3HZN54498210OtherHORIZON BCBS