Provider Demographics
NPI:1972714210
Name:KRUVANT, AMY (LCSW, BCIA-EEG)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KRUVANT
Suffix:
Gender:F
Credentials:LCSW, BCIA-EEG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BLACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4170
Mailing Address - Country:US
Mailing Address - Phone:973-226-5039
Mailing Address - Fax:973-403-9602
Practice Address - Street 1:11 BLACKBERRY LN
Practice Address - Street 2:
Practice Address - City:NORTH CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-4170
Practice Address - Country:US
Practice Address - Phone:973-226-5039
Practice Address - Fax:973-403-9602
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC048204001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical