Healthcare Provider Details

I. General information

NPI: 1962239400
Provider Name (Legal Business Name): LAURIENNA S KURUCZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LU S KURUCZ

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 JAMES ONEILL ST
BOSTON MA
02127-4504
US

IV. Provider business mailing address

1010 MASSACHUSETTS AVE FL 2
BOSTON MA
02118-2853
US

V. Phone/Fax

Practice location:
  • Phone: 617-534-9500
  • Fax:
Mailing address:
  • Phone: 617-534-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: