Healthcare Provider Details

I. General information

NPI: 1225331986
Provider Name (Legal Business Name): JENNIFER MARIE KUZMIN LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 STATE ST STE 1409
ERIE PA
16501
US

IV. Provider business mailing address

1001 STATE ST STE 1409
ERIE PA
16501-1814
US

V. Phone/Fax

Practice location:
  • Phone: 814-860-6792
  • Fax:
Mailing address:
  • Phone: 814-860-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC005712
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: