Healthcare Provider Details

I. General information

NPI: 1629121991
Provider Name (Legal Business Name): GEORGE PATRICK ZURENDA JR. LCSW-R
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: G. P. ZURENDA LCSW-R

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 N AURORA ST
ITHACA NY
14850-4360
US

IV. Provider business mailing address

PO BOX 660
ITHACA NY
14851-0660
US

V. Phone/Fax

Practice location:
  • Phone: 607-272-1911
  • Fax: 607-272-1911
Mailing address:
  • Phone: 607-227-1911
  • Fax: 607-272-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR043285
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: