Provider Demographics
NPI:1912511759
Name:KRUEGER, ELLEN JOANNE (MHC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:JOANNE
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 55TH ST APT 16D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5134
Mailing Address - Country:US
Mailing Address - Phone:917-860-6703
Mailing Address - Fax:
Practice Address - Street 1:122 W 26TH ST RM 702
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6804
Practice Address - Country:US
Practice Address - Phone:917-860-6703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003823101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health