Provider Demographics
NPI:1114156627
Name:KEZUR, DAVID (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:KEZUR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 LEXINGTON AVE
Mailing Address - Street 2:SUITE 1 H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1109
Mailing Address - Country:US
Mailing Address - Phone:212-360-6216
Mailing Address - Fax:
Practice Address - Street 1:1327 LEXINGTON AVE
Practice Address - Street 2:SUITE 1 H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1109
Practice Address - Country:US
Practice Address - Phone:212-360-6216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO 39627-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical