Healthcare Provider Details

I. General information

NPI: 1386701209
Provider Name (Legal Business Name): EVELYN KUNTZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 PARK AVE
WILLISTON PARK NY
11596-1627
US

IV. Provider business mailing address

55 PARK AVE
WILLISTON PARK NY
11596-1627
US

V. Phone/Fax

Practice location:
  • Phone: 516-877-1424
  • Fax: 516-294-7375
Mailing address:
  • Phone: 516-877-1424
  • Fax: 516-294-7375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL18194
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: