Healthcare Provider Details

I. General information

NPI: 1649810417
Provider Name (Legal Business Name): JAZMIN CRUZ KUZMACK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAZMIN CRUZ FLORES LMSW

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 09/19/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 WEST SANETTA ST.
NAMPA ID
83651
US

IV. Provider business mailing address

1650 S TOPAZ WAY
MERIDIAN ID
83642-4474
US

V. Phone/Fax

Practice location:
  • Phone: 208-576-6464
  • Fax:
Mailing address:
  • Phone: 208-605-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLMSW-40804
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: