Healthcare Provider Details

I. General information

NPI: 1972714210
Provider Name (Legal Business Name): AMY KRUVANT LCSW, BCIA-EEG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BLACKBERRY LN
NORTH CALDWELL NJ
07006-4170
US

IV. Provider business mailing address

11 BLACKBERRY LN
NORTH CALDWELL NJ
07006-4170
US

V. Phone/Fax

Practice location:
  • Phone: 973-226-5039
  • Fax: 973-403-9602
Mailing address:
  • Phone: 973-226-5039
  • Fax: 973-403-9602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04820400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: