MEDICARE: MISS JESSE SUZANNE KUZMAN IMF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07533	OTHER	CA	ADOL TX ANTIOCH
2	07551	OTHER	CA	ADULT TX BRENTWOOD
3	07557	OTHER	CA	DMC ADOL BRENTWOOD
4	07536	OTHER	CA	DMC ADOL ANTIOCH
5	07555	OTHER	CA	DRUG COURT
6	07531	OTHER	CA	ADULT TX ANTIOCH
7	07552	OTHER	CA	DMC ADULT BRENTWOOD
8	07534	OTHER	CA	DMC ADULT ANTIOCH
9	07553	OTHER	CA	ADOL TX BRENTWOOD
10	070753	OTHER	CA	MASTER PROVIDER NUMBER
11	0726	OTHER	CA	DRUG M/CAL BILLING NUM
12	0753	OTHER	CA	DRUG M/CAL BILLING NUM

General Provider Information

NPI Number	:	1164600748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JESSE SUZANNE KUZMAN IMF

Provider Business Mailing Address
First Line	:	35 CONGRESS ST
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-5529
Country	:	US
Telephone Number	:	978-542-1951
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 CONGRESS ST
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-5529
Country	:	US
Telephone Number	:	978-542-1951
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	07/28/2014

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