Provider Demographics
NPI:1790747640
Name:KURYS, TINA M (LICSW)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:KURYS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4225
Mailing Address - Country:US
Mailing Address - Phone:617-731-3207
Mailing Address - Fax:
Practice Address - Street 1:1330 BEACON ST.
Practice Address - Street 2:SUITE 225
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446
Practice Address - Country:US
Practice Address - Phone:617-332-2700
Practice Address - Fax:617-277-4752
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10300301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P07454Medicare UPIN
KUP20909Medicare ID - Type Unspecified