Provider Demographics
NPI:1750768008
Name:KRUK, NECHAMA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:NECHAMA
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 1:35 KINGSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3090
Mailing Address - Country:US
Mailing Address - Phone:732-330-5403
Mailing Address - Fax:
Practice Address - Street 1:35 KINGSFIELD DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3090
Practice Address - Country:US
Practice Address - Phone:732-330-5403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055818001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical