Provider Demographics
NPI:1871791384
Name:KRUSINSKI, REBECCA BETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:BETH
Last Name:KRUSINSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:BETH
Other - Last Name:EWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:602 AUTUMN CHASE
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-3740
Mailing Address - Country:US
Mailing Address - Phone:860-869-8819
Mailing Address - Fax:
Practice Address - Street 1:602 AUTUMN CHASE
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-3740
Practice Address - Country:US
Practice Address - Phone:860-869-8819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0060561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical