Healthcare Provider Details

I. General information

NPI: 1851489595
Provider Name (Legal Business Name): KATHLEEN ANNE KUCZYNSKI DSW MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAY ANNE KUCZYNSKI DSW MSW

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST UNAKA AVE
JOHNSON CITY TN
37601
US

IV. Provider business mailing address

600 EAST UNAKA AVE
JOHNSON CITY TN
37601-4035
US

V. Phone/Fax

Practice location:
  • Phone: 423-928-0005
  • Fax:
Mailing address:
  • Phone: 423-928-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW454
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: