Provider Demographics
NPI:1225626724
Name:KURTZ, CAROL (MA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:KURTZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 LAWNDALE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-3024
Mailing Address - Country:US
Mailing Address - Phone:301-672-3649
Mailing Address - Fax:
Practice Address - Street 1:9700 LAWNDALE DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-3024
Practice Address - Country:US
Practice Address - Phone:301-672-3649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0113103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical