Healthcare Provider Details

I. General information

NPI: 1548090632
Provider Name (Legal Business Name): LAURA KRUCZINSKI MSW, LLMSW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23231 WOODWARD AVE
FERNDALE MI
48220-1361
US

IV. Provider business mailing address

23231 WOODWARD AVE
FERNDALE MI
48220-1361
US

V. Phone/Fax

Practice location:
  • Phone: 248-581-8777
  • Fax:
Mailing address:
  • Phone: 248-581-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851118809APP24
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: