Provider Demographics
NPI:1437802949
Name:LUZZI, KIRAN H
Entity Type:Individual
Prefix:MRS
First Name:KIRAN
Middle Name:H
Last Name:LUZZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 CHAMBERLIN ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5505
Mailing Address - Country:US
Mailing Address - Phone:516-639-8470
Mailing Address - Fax:
Practice Address - Street 1:75 HORTON AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1420
Practice Address - Country:US
Practice Address - Phone:516-434-2825
Practice Address - Fax:516-256-0163
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst