1760514400 NPI number — MRS. KATHLEEN JAMES KURTZ LCSW

Table of content: MRS. KATHLEEN JAMES KURTZ LCSW (NPI 1760514400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760514400 NPI number — MRS. KATHLEEN JAMES KURTZ LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KURTZ
Provider First Name:
KATHLEEN
Provider Middle Name:
JAMES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRAVES
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760514400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5979 NW 151 ST
Provider Second Line Business Mailing Address:
201
Provider Business Mailing Address City Name:
MIAMI LAKES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-823-7314
Provider Business Mailing Address Fax Number:
305-823-3014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5979 NW 151 ST
Provider Second Line Business Practice Location Address:
201
Provider Business Practice Location Address City Name:
MIAMI LAKES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-823-7314
Provider Business Practice Location Address Fax Number:
305-823-3014
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  SW471 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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