Provider Demographics
NPI:1164600748
Name:KUZMAN, JESSE SUZANNE (IMF)
Entity Type:Individual
Prefix:MISS
First Name:JESSE
Middle Name:SUZANNE
Last Name:KUZMAN
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5529
Mailing Address - Country:US
Mailing Address - Phone:978-542-1951
Mailing Address - Fax:
Practice Address - Street 1:35 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5529
Practice Address - Country:US
Practice Address - Phone:978-542-1951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA07533OtherADOL TX ANTIOCH
CA07551OtherADULT TX BRENTWOOD
CA07557OtherDMC ADOL BRENTWOOD
CA07536OtherDMC ADOL ANTIOCH
CA07555OtherDRUG COURT
CA07531OtherADULT TX ANTIOCH
CA07552OtherDMC ADULT BRENTWOOD
CA07534OtherDMC ADULT ANTIOCH
CA07553OtherADOL TX BRENTWOOD
CA070753OtherMASTER PROVIDER NUMBER
CA0726OtherDRUG M/CAL BILLING NUM
CA0753OtherDRUG M/CAL BILLING NUM