Healthcare Provider Details

I. General information

NPI: 1710452883
Provider Name (Legal Business Name): DIANNE KUZIA HILLS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 WILLOW ST
LYNN MA
01901-1109
US

IV. Provider business mailing address

98 WILLOW ST
LYNN MA
01901-1109
US

V. Phone/Fax

Practice location:
  • Phone: 781-595-3224
  • Fax: 781-595-0113
Mailing address:
  • Phone:
  • Fax: 781-595-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113415
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: