Provider Demographics
NPI:1639267537
Name:KURJAN, MICHAEL S (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:S
Last Name:KURJAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 FLANDERS RD STE C
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1711
Mailing Address - Country:US
Mailing Address - Phone:860-691-2648
Mailing Address - Fax:860-399-5077
Practice Address - Street 1:315 FLANDERS RD STE C
Practice Address - Street 2:
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1711
Practice Address - Country:US
Practice Address - Phone:860-691-2648
Practice Address - Fax:860-399-5077
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0020921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
140002092CT02OtherANTHEM BCBS OF CT
140002092CT02OtherANTHEM BCBS OF CT