Provider Demographics
NPI:1871041384
Name:KRUZEL, REBEKAH JASMIN (LMSW)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:JASMIN
Last Name:KRUZEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:JASMIN
Other - Last Name:VALENTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1975 ELM TER
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-7127
Mailing Address - Country:US
Mailing Address - Phone:269-208-4460
Mailing Address - Fax:
Practice Address - Street 1:3134 NILES RD ST. C
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-8652
Practice Address - Country:US
Practice Address - Phone:269-408-8235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801096308101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)