MR. SEAN ADRIAN KRUCKENBERG LCSW
NPI 1871079665
Social Worker - Clinical in Ontario, CA

Q: What is Sean Kruckenberg's NPI number?

The NPI number for Sean Kruckenberg is 1871079665. It was assigned to this individual provider in the NPPES registry on July 14, 2018.

Q: What is Sean Kruckenberg's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Q: When was this NPI record last updated?

The NPPES record for Sean Kruckenberg was last updated on June 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 14, 2018PECOS Enrolled

2940 INLAND EMPIRE BLVD, ONTARIO, CA 91764(909) 808-0967 Get Directions Write a Review

NPPES record last updated: June 10, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 8, 2024, Jan 26, 2022, Jul 14, 2018 (3 updates tracked since 2018).

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About Mr. Sean Adrian Kruckenberg Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. SEAN ADRIAN KRUCKENBERG LCSW (NPI 1871079665) is an individual clinical provider in Ontario, California, licensed in California (LCSW121455) and active in the NPI registry since July 2018. He is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1871079665

Entity TypeIndividualMale

Primary Taxonomy1041C0700X

Provider Legal NameMR. SEAN ADRIAN KRUCKENBERGCredential: LCSW

Location Address2940 INLAND EMPIRE BLVDOntario, CA 91764-4898

Mailing Address2940 Inland Empire BlvdOntario, CA 91764-4898 · (909) 808-0967

Phone(909) 808-0967

Sole ProprietorNo

Medical School CMSOtherGraduated 2021

Enumeration DateJuly 14, 2018

Last NPPES UpdateJune 10, 20263 updates tracked since enumeration

NPPES CertifiedJune 10, 2026

✔ NPI 1871079665 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code1041C0700X

Licenses✔ Licensed in CA · LCSW121455✔ Licensed in CA · 121455

Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License 104512 (CA)

Also ListedSocial WorkerTaxonomy 104100000X · License 104512 (CA)

2940 INLAND EMPIRE BLVD, Ontario, CA 91764

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Sean Adrian Kruckenberg Lcsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9234695859

PECOS Enrollment IDI20260803002674

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Sean Kruckenberg reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

County Of San Bernardino

Same address

Clinic/Center

2940 INLAND EMPIRE BLVD
Ontario, CA 91764

Reassigned Medicare billing, California enrollment
233 clinicians in this Medicare group

NPI 1841407061 (909) 458-1350

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 91764 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$0.00 typical visit price

range $59.60 – $179.42

Typical copayment $0.00 (range $14.90 – $44.85)

Most-billed visit code NA

Established Patient

$74.08 typical visit price

range $19.37 – $146.42

Typical copayment $18.52 (range $4.84 – $36.60)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GOLEANIA CHERIC DARRETT

Counselor (Addiction (Substance Use Disorder))