Provider Demographics
NPI:1417938101
Name:EVELYN KUNTZ LCSW PC
Entity Type:Organization
Organization Name:EVELYN KUNTZ LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-877-1424
Mailing Address - Street 1:55 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-1627
Mailing Address - Country:US
Mailing Address - Phone:516-877-1424
Mailing Address - Fax:516-294-7375
Practice Address - Street 1:55 PARK AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-1627
Practice Address - Country:US
Practice Address - Phone:516-877-1424
Practice Address - Fax:516-294-7375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL181941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYL18194OtherNY STATE LIC #
NYN3W671Medicare PIN