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NPI Code Detail

MEDICARE: MS. THERESA KERZNER LMSW

MEDICARE: MS. THERESA KERZNER LMSW
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
1101Y00000XCounselor
2104100000XSocial Worker073266NY

General Provider Information

NPI Number : 1902872112
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. THERESA KERZNER LMSW
Provider Business Mailing Address
First Line : 200 DUNHAM AVE
Second Line :
City : JAMESTOWN
State : NY
Zip : 14701-2528
Country : US
Telephone Number : 716-661-1057
Fax Number :
Provider Business Practice Location Address
First Line : 7755 ROUTE 83
Second Line :
City : SOUTH DAYTON
State : NY
Zip : 14138-9633
Country : US
Telephone Number : 716-499-1317
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 11/18/2014

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