Healthcare Provider Details

I. General information

NPI: 1639305105
Provider Name (Legal Business Name): JAN ANDREW KUZNIK B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 FRENCH KING HIGHWAY FST- SERVICENET, INC.
GREENFIELD MA
01301
US

IV. Provider business mailing address

63 FRENCH KING HIGHWAY FST- SERVICENET, INC.
GREENFIELD MA
01301
US

V. Phone/Fax

Practice location:
  • Phone: 413-386-3719
  • Fax: 413-772-0097
Mailing address:
  • Phone: 413-386-3719
  • Fax: 413-772-0097

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: