Healthcare Provider Details

I. General information

NPI: 1972714665
Provider Name (Legal Business Name): NICOLE S KUZMICIC MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 20TH ST S SUITE 101
BIRMINGHAM AL
35205-2610
US

IV. Provider business mailing address

1530 3RD AVE S CH19 - 307
BIRMINGHAM AL
35294-0002
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-5471
  • Fax: 205-975-2380
Mailing address:
  • Phone: 205-934-5471
  • Fax: 205-975-2380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1638G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: