Provider Demographics
NPI:1285290163
Name:CRUYS, CAROLINE (LGSW)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:CRUYS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:CAROLINE
Other - Last Name:CRUYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:3328 CEDAR AVE S APT 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-2335
Mailing Address - Country:US
Mailing Address - Phone:931-302-5110
Mailing Address - Fax:
Practice Address - Street 1:1821 UNIVERSITY AVE W STE N385
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2872
Practice Address - Country:US
Practice Address - Phone:612-454-2473
Practice Address - Fax:651-647-9147
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN275261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical