Healthcare Provider Details

I. General information

NPI: 1447568092
Provider Name (Legal Business Name): AMANDA KUCINSKI LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W MAIN ST
NORTON MA
02766-1248
US

IV. Provider business mailing address

108 W MAIN ST
NORTON MA
02766-1248
US

V. Phone/Fax

Practice location:
  • Phone: 508-285-9400
  • Fax:
Mailing address:
  • Phone: 508-285-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number215867
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number117534
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: