Healthcare Provider Details

I. General information

NPI: 1134448061
Provider Name (Legal Business Name): JANET MARIE KRUSICK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 DON PASQUAL RD NW
LOS LUNAS NM
87031-8493
US

IV. Provider business mailing address

22 DESERT MOUNTAIN RD
PLACITAS NM
87043-9552
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-3350
  • Fax:
Mailing address:
  • Phone: 505-379-5689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-07242
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: