Healthcare Provider Details

I. General information

NPI: 1972559169
Provider Name (Legal Business Name): MARGARET VAN KUREN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FLAHERTY RD
STORRS MANSFIELD CT
06268-2301
US

IV. Provider business mailing address

25 ANTON RD APT C
STORRS MANSFIELD CT
06268-1182
US

V. Phone/Fax

Practice location:
  • Phone: 860-617-0510
  • Fax:
Mailing address:
  • Phone: 860-617-0510
  • Fax: 860-429-8618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002483
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: