Provider Demographics
NPI:1417118266
Name:KURTZ, GERALD A (PHD,)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:A
Last Name:KURTZ
Suffix:
Gender:M
Credentials:PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 W 16TH DR
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4412
Mailing Address - Country:US
Mailing Address - Phone:305-343-4441
Mailing Address - Fax:305-558-8017
Practice Address - Street 1:6905 W 16TH DR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4412
Practice Address - Country:US
Practice Address - Phone:305-343-4441
Practice Address - Fax:305-558-8017
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW07471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical