Provider Demographics
NPI:1831474212
Name:KURGAN, ROBERTA ANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:ANNE
Last Name:KURGAN
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 1:418 ALBANY HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:RENSSELAERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12147
Mailing Address - Country:US
Mailing Address - Phone:518-797-5113
Mailing Address - Fax:
Practice Address - Street 1:418 ALBANY HILL RD
Practice Address - Street 2:
Practice Address - City:RENSSELAERVILLE
Practice Address - State:NY
Practice Address - Zip Code:12147-2704
Practice Address - Country:US
Practice Address - Phone:518-797-5113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0788911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical