Provider Demographics
NPI:1679917629
Name:KURTZ, STACY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:KURTZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 FRANKLIN AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2938
Mailing Address - Country:US
Mailing Address - Phone:516-234-6794
Mailing Address - Fax:
Practice Address - Street 1:1044 FRANKLIN AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2938
Practice Address - Country:US
Practice Address - Phone:516-234-6794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021234103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical