Provider Demographics
NPI:1518945294
Name:KURTZ, ALAN (EDD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:KURTZ
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MONTAGUE ROAD
Mailing Address - Street 2:
Mailing Address - City:SHUTESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01072
Mailing Address - Country:US
Mailing Address - Phone:413-746-3932
Mailing Address - Fax:413-746-3932
Practice Address - Street 1:10 CENTRAL STREET
Practice Address - Street 2:SUITE 27
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089
Practice Address - Country:US
Practice Address - Phone:413-746-3932
Practice Address - Fax:413-746-3932
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4093103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0503941Medicaid
MAW50943Medicare ID - Type Unspecified
MA0503941Medicaid