Provider Demographics
NPI:1306482419
Name:KURTZ, TAYLOR (PSYD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:KURTZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GLENBROOK RD APT 3A
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2949
Mailing Address - Country:US
Mailing Address - Phone:203-912-3674
Mailing Address - Fax:
Practice Address - Street 1:85 OLD KINGS HWY N
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4732
Practice Address - Country:US
Practice Address - Phone:203-202-7654
Practice Address - Fax:203-202-7655
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool