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NPI Code Detail

MEDICARE: MR. C THOMAS KUTZ LCSW

MEDICARE: MR. C THOMAS KUTZ LCSW
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
11041C0700XClinical Social WorkerLCS-4209CA

General Provider Information

NPI Number : 1780807297
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. C THOMAS KUTZ LCSW
Provider Business Mailing Address
First Line : 4879 E KINGS CANYON RD
Second Line :
City : FRESNO
State : CA
Zip : 93727-3811
Country : US
Telephone Number : 559-255-8395
Fax Number : 559-452-8194
Provider Business Practice Location Address
First Line : 4879 E KINGS CANYON RD
Second Line :
City : FRESNO
State : CA
Zip : 93727-3811
Country : US
Telephone Number : 559-255-8395
Fax Number : 559-452-8194
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2007
Last Update Date : 07/08/2007

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