Provider Demographics
NPI:1558491985
Name:DUSZYNSKI, KENNETH JAMES (MED CRC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JAMES
Last Name:DUSZYNSKI
Suffix:
Gender:M
Credentials:MED CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 WALDEN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4965
Mailing Address - Country:US
Mailing Address - Phone:716-895-7167
Mailing Address - Fax:716-332-4488
Practice Address - Street 1:1526 WALDEN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4965
Practice Address - Country:US
Practice Address - Phone:716-895-7167
Practice Address - Fax:716-332-4488
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2815101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health