Provider Demographics
NPI:1154530178
Name:KRULAK, AMY V (LCSW-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:V
Last Name:KRULAK
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 CLIPPER PARK RD
Mailing Address - Street 2:SUITE 110, IN AVALON WELLNESS
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1405
Mailing Address - Country:US
Mailing Address - Phone:410-336-4271
Mailing Address - Fax:
Practice Address - Street 1:2002 CLIPPER PARK RD
Practice Address - Street 2:SUITE 110, IN AVALON WELLNESS
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1405
Practice Address - Country:US
Practice Address - Phone:410-336-4271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD82201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical