Healthcare Provider Details

I. General information

NPI: 1770533101
Provider Name (Legal Business Name): JOHN KUCHINSKAS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 S 7TH ST
TERRE HAUTE IN
47802-4367
US

IV. Provider business mailing address

PO BOX 4323
TERRE HAUTE IN
47804-0323
US

V. Phone/Fax

Practice location:
  • Phone: 812-231-8133
  • Fax: 812-232-9365
Mailing address:
  • Phone: 812-231-8323
  • Fax: 812-231-8400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34002216
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: