Provider Demographics
NPI:1740686476
Name:KUKUK, CRAIG ARTHUR (LCSW)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ARTHUR
Last Name:KUKUK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SCIPIO CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13147-4107
Mailing Address - Country:US
Mailing Address - Phone:734-717-7719
Mailing Address - Fax:
Practice Address - Street 1:2345 CENTER RD
Practice Address - Street 2:
Practice Address - City:SCIPIO CENTER
Practice Address - State:NY
Practice Address - Zip Code:13147-4107
Practice Address - Country:US
Practice Address - Phone:734-717-7719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0813381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical