Provider Demographics
NPI:1497981609
Name:KURTZ, SUSAN A (LSW, LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:A
Last Name:KURTZ
Suffix:
Gender:F
Credentials:LSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 MUMMA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WORMLEYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1145
Mailing Address - Country:US
Mailing Address - Phone:717-303-5960
Mailing Address - Fax:717-303-5962
Practice Address - Street 1:1017 MUMMA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WORMLEYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17043-1145
Practice Address - Country:US
Practice Address - Phone:717-303-5960
Practice Address - Fax:717-303-5962
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW124839104100000X
PAPC005503101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker