Healthcare Provider Details

I. General information

NPI: 1558053512
Provider Name (Legal Business Name): STEPHANIE KUCZINSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5258 WINDSOR PARKE DR
BOCA RATON FL
33496-1601
US

IV. Provider business mailing address

5258 WINDSOR PARKE DR
BOCA RATON FL
33496-1601
US

V. Phone/Fax

Practice location:
  • Phone: 914-420-9969
  • Fax:
Mailing address:
  • Phone: 914-420-9969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW21160
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: