Healthcare Provider Details

I. General information

NPI: 1417612342
Provider Name (Legal Business Name): STEVEN KUCHUCK LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W 14TH ST APT 5M
NEW YORK NY
10011-7255
US

IV. Provider business mailing address

222 W 14TH ST APT 5M
NEW YORK NY
10011-7255
US

V. Phone/Fax

Practice location:
  • Phone: 212-463-0758
  • Fax:
Mailing address:
  • Phone: 212-463-0758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR038641
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: