Provider Demographics
NPI:1386920296
Name:KREUZBERGER, CHRISTIAN ALLEN (LCSW)
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:ALLEN
Last Name:KREUZBERGER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PROMENADE AVE
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-2952
Mailing Address - Country:US
Mailing Address - Phone:207-205-1943
Mailing Address - Fax:
Practice Address - Street 1:4 PROMENADE AVE
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-2952
Practice Address - Country:US
Practice Address - Phone:207-205-1943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC146631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1386920296OtherUCBH 10/212011