Healthcare Provider Details

I. General information

NPI: 1316222623
Provider Name (Legal Business Name): KAREN E KRUGER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9180 GALLERIA COURT SUITE 300
NAPLES FL
34109
US

IV. Provider business mailing address

9180 GALLERIA COURT SUITE 300
NAPLES FL
34109
US

V. Phone/Fax

Practice location:
  • Phone: 239-841-2010
  • Fax: 239-841-2010
Mailing address:
  • Phone: 239-841-2010
  • Fax: 239-841-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY8414
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: