Basic Information
| Provider Information | |||||||||
| NPI: | 1386786705 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRUGOVOY | ||||||||
| FirstName: | CLAUDIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 189 MONTAGUE ST | ||||||||
| Address2: | SUITE 418 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112013610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188755625 | ||||||||
| FaxNumber: | 7188756876 | ||||||||
| Practice Location | |||||||||
| Address1: | 189 MONTAGUE ST | ||||||||
| Address2: | SUITE 436 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112013610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188757510 | ||||||||
| FaxNumber: | 7186433455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 069263-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 069263-1 | 05 | NY | MEDICAID |