MEDICARE: EVELYN KUNTZ LCSW PC

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	1041C0700X	Clinical Social Worker	L18194	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L18194	OTHER	NY	NY STATE LIC #

General Provider Information

NPI Number	:	1417938101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVELYN KUNTZ LCSW PC

Provider Business Mailing Address
First Line	:	55 PARK AVE
Second Line	:
City	:	WILLISTON PARK
State	:	NY
Zip	:	11596-1627
Country	:	US
Telephone Number	:	516-877-1424
Fax Number	:	516-294-7375

Provider Business Practice Location Address
First Line	:	55 PARK AVE
Second Line	:
City	:	WILLISTON PARK
State	:	NY
Zip	:	11596-1627
Country	:	US
Telephone Number	:	516-877-1424
Fax Number	:	516-294-7375

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. EVELYN KUNTZ
Credential	:	LCSW
Telephone Number	:	516-877-1424

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	03/27/2015

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