MEDICARE: JACLYN A KURZ LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	100742-01	NY

General Provider Information

NPI Number	:	1437919131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN A KURZ LMSW

Provider Business Mailing Address
First Line	:	35 SPRING ST
Second Line	:
City	:	COLD SPRING HARBOR
State	:	NY
Zip	:	11724-1409
Country	:	US
Telephone Number	:	516-840-2143
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 SPRING ST
Second Line	:
City	:	COLD SPRING HARBOR
State	:	NY
Zip	:	11724-1409
Country	:	US
Telephone Number	:	516-840-2143
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2024
Last Update Date	:	03/20/2024

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