Provider Demographics
NPI:1356103576
Name:KRAUTWURST, KARISSA JANE (BS, CASAC)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:JANE
Last Name:KRAUTWURST
Suffix:
Gender:F
Credentials:BS, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BRUSH HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3003
Mailing Address - Country:US
Mailing Address - Phone:585-748-4721
Mailing Address - Fax:
Practice Address - Street 1:150 MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1016
Practice Address - Country:US
Practice Address - Phone:585-287-5626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35601101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)