Active NPI
Samuel Krebsbach, APSW, SAC - IT
- Social Worker
- Milwaukee, WI
National Provider Identifier
1720470065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 129620
- Practice address
- 4757 N 76TH St
Milwaukee, WI 53218-4732 - Phone
- (414) 476-3710
- NPI assigned
- Feb 24, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 17284 | WI | |
| Social Worker | 104100000X | 129620 | WI | Primary |
Addresses
Primary practice location
4757 N 76TH St
Milwaukee, WI 53218-4732
Mailing address
4757 N 76TH St
Milwaukee, WI 53218-4732
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17284 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 129620 | WI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424736000000",
"number": "1720470065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4757 N 76TH ST",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532184732"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4757 N 76TH ST",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532184732",
"telephone_number": "414-476-3710"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KREBSBACH",
"first_name": "SAMUEL",
"credential": "APSW, SAC - IT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-02-24",
"last_updated": "2015-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "17284",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "WI",
"license": "129620",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.