Healthcare Provider Details

I. General information

NPI: 1164196127
Provider Name (Legal Business Name): ANGELINE KRUEGER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 ADAMS AVE
SAN DIEGO CA
92116-1401
US

IV. Provider business mailing address

3030 SUNCREST DR UNIT 114
SAN DIEGO CA
92116-1532
US

V. Phone/Fax

Practice location:
  • Phone: 951-970-7861
  • Fax:
Mailing address:
  • Phone: 951-970-7861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number416515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: