Healthcare Provider Details

I. General information

NPI: 1982697199
Provider Name (Legal Business Name): WILLIAM J KUZBYT PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4061 BONITA BEACH RD STE 105
BONITA SPRINGS FL
34134-4073
US

IV. Provider business mailing address

4061 BONITA BEACH RD STE 105
BONITA SPRINGS FL
34134-4073
US

V. Phone/Fax

Practice location:
  • Phone: 239-221-3399
  • Fax: 239-300-2759
Mailing address:
  • Phone: 352-793-5900
  • Fax: 352-793-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY6646
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: