Provider Demographics
NPI:1972525848
Name:KUTNER, KENNETH CRAIG (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CRAIG
Last Name:KUTNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 CURRY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1794
Mailing Address - Country:US
Mailing Address - Phone:201-894-0050
Mailing Address - Fax:
Practice Address - Street 1:440 CURRY AVE STE B
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1794
Practice Address - Country:US
Practice Address - Phone:201-894-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2135103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical