Provider Demographics
NPI:1548977259
Name:KRUSICH, SETH ALLEN (LCSW)
Entity type:Individual
Prefix:MR
First Name:SETH
Middle Name:ALLEN
Last Name:KRUSICH
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 1:1008 STOWBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-5072
Mailing Address - Country:US
Mailing Address - Phone:859-433-8711
Mailing Address - Fax:
Practice Address - Street 1:1008 STOWBRIDGE LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-5072
Practice Address - Country:US
Practice Address - Phone:859-433-8711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2571891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical