Healthcare Provider Details

I. General information

NPI: 1457746075
Provider Name (Legal Business Name): GEORGE WURZER III LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MAIN ST
HEMPSTEAD NY
11550-4020
US

IV. Provider business mailing address

16 MAIN ST
HEMPSTEAD NY
11550-4020
US

V. Phone/Fax

Practice location:
  • Phone: 516-489-2322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number074350
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: