Individual
AMANDA GLEE CRUSOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
306 E MAIN ST, STOCKTON, CA 95202-2908
(209) 707-6247
Mailing address
306 E MAIN ST, STOCKTON, CA 95202-2908
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
115828
CA
Other
Enumeration date
02/05/2020
Last updated
06/22/2023
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