Provider Demographics
NPI:1407566441
Name:KUCZERA, LINDSAY (LMSW)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:KUCZERA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 E BELTLINE AVE SE STE G268
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5987
Mailing Address - Country:US
Mailing Address - Phone:616-284-1694
Mailing Address - Fax:
Practice Address - Street 1:2500 E BELTLINE AVE SE STE G268
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5987
Practice Address - Country:US
Practice Address - Phone:616-284-1694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801098136104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker