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General NPI Number Information
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NPI Number | 1518480706
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Entity Type | Individual
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Provider Name | STACIE MARIE KRUZINSKI LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 2480 S WOODWORTH LOOP STE 285
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City | PALMER
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State | AK
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Zip | 99645-7408
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Country | US
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Telephone | 907-861-6035
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Fax | 907-861-6039
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Provider Business Mailing Address
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Address Line | PO BOX 689022
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City | FRANKLIN
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State | TN
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Zip | 37068-9022
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Country | US
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Telephone | 615-465-7211
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 080896
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 230116
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License Number State | AK
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