Provider Demographics
NPI:1740661727
Name:KUZMINA, IRINA
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:KUZMINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12773 FOREST HILL BLVD STE 1206
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4760
Mailing Address - Country:US
Mailing Address - Phone:541-206-0802
Mailing Address - Fax:
Practice Address - Street 1:12773 FOREST HILL BLVD STE 1206
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4760
Practice Address - Country:US
Practice Address - Phone:541-206-0802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC7569101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health