Healthcare Provider Details

I. General information

NPI: 1417938101
Provider Name (Legal Business Name): EVELYN KUNTZ LCSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 03/27/2015
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: MS. EVELYN KUNTZ
Title or Position: PRESIDENT
Credential: LCSW
Phone: 516-877-1424