Healthcare Provider Details

I. General information

NPI: 1477649440
Provider Name (Legal Business Name): LILIANA BEATRIZ KRUKOWSKI LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MAIN ST
NYACK NY
10960-3109
US

IV. Provider business mailing address

99 MAIN ST # 526
NYACK NY
10960-3109
US

V. Phone/Fax

Practice location:
  • Phone: 718-490-8030
  • Fax:
Mailing address:
  • Phone: 718-490-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number061262
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: