Provider Demographics
NPI:1710387402
Name:GURDAK, KRISTEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:GURDAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 NW 44TH TER APT 103
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9203
Mailing Address - Country:US
Mailing Address - Phone:561-843-9497
Mailing Address - Fax:
Practice Address - Street 1:5719 NW 81ST TER
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4528
Practice Address - Country:US
Practice Address - Phone:561-350-3864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical