Individual
LILY S KRUTEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
833 SE MAIN ST # 213, PORTLAND, OR 97214-3454
(510) 626-0215
Mailing address
833 SE MAIN ST., BOX 302, PORTLAND, OR 97214-3427
(510) 626-0215
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW100095
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCSW100095
CA BOARD OF BEHAVIORAL SCIENCES
CA
Enumeration date
09/10/2014
Last updated
10/23/2024
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