Provider Demographics
NPI:1285290163
Name:CRUYS, SAMANTHA (LCSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:CRUYS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARO
Other - Middle Name:
Other - Last Name:CRUYS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1022 JENIFER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-4563
Mailing Address - Country:US
Mailing Address - Phone:931-302-5110
Mailing Address - Fax:
Practice Address - Street 1:725 HEARTLAND TRL STE 301
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1978
Practice Address - Country:US
Practice Address - Phone:608-205-4450
Practice Address - Fax:608-205-4450
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN275261041C0700X
WI12497-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical