Provider Demographics
NPI:1093233371
Name:KURCZAK, DYLAN R (LMHC)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:R
Last Name:KURCZAK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:DYLAN
Other - Middle Name:R
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 1159
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1159
Mailing Address - Country:US
Mailing Address - Phone:310-488-0204
Mailing Address - Fax:
Practice Address - Street 1:115R S MAIN ST
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MA
Practice Address - Zip Code:02779-2026
Practice Address - Country:US
Practice Address - Phone:339-545-1694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC12549101YM0800X
MA12549-MH-CC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health