Healthcare Provider Details

I. General information

NPI: 1891129078
Provider Name (Legal Business Name): PHILIP MICHAEL KUTSCHERA LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2013
Last Update Date: 08/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 BURDETT AVE
TROY NY
12180-2466
US

IV. Provider business mailing address

35 2ND AVE APT B
RENSSELAER NY
12144-2889
US

V. Phone/Fax

Practice location:
  • Phone: 151-827-1330
  • Fax:
Mailing address:
  • Phone: 151-836-4547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number089891
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: