Provider Demographics
NPI:1629121991
Name:ZURENDA, GEORGE PATRICK JR (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:PATRICK
Last Name:ZURENDA
Suffix:JR
Gender:M
Credentials:LCSW-R
Other - Prefix:MR
Other - First Name:G.
Other - Middle Name:P
Other - Last Name:ZURENDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14851-0660
Mailing Address - Country:US
Mailing Address - Phone:607-227-1911
Mailing Address - Fax:607-272-1911
Practice Address - Street 1:213 N AURORA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4360
Practice Address - Country:US
Practice Address - Phone:607-272-1911
Practice Address - Fax:607-272-1911
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0432851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical