Provider Demographics
NPI:1831113653
Name:KURTZ, CAROLYN MINERVA (MSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MINERVA
Last Name:KURTZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31010 STARDUST LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-3441
Mailing Address - Country:US
Mailing Address - Phone:760-580-1321
Mailing Address - Fax:760-749-7868
Practice Address - Street 1:31010 STARDUST LN
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-3441
Practice Address - Country:US
Practice Address - Phone:760-580-1321
Practice Address - Fax:760-749-7868
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 39181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical