Provider Demographics
NPI:1073227534
Name:CURTIS, KENTON JAMES (MSW)
Entity Type:Individual
Prefix:
First Name:KENTON
Middle Name:JAMES
Last Name:CURTIS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BENNETT AVE APT 3G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3842
Mailing Address - Country:US
Mailing Address - Phone:917-470-1509
Mailing Address - Fax:
Practice Address - Street 1:200 BENNETT AVE APT 3G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3842
Practice Address - Country:US
Practice Address - Phone:917-470-1509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077347-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical