Provider Demographics
NPI:1770615650
Name:KUZMA, CHARLENE LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:LYNN
Last Name:KUZMA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11483 SW 160TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSE HILL
Mailing Address - State:KS
Mailing Address - Zip Code:67133-7801
Mailing Address - Country:US
Mailing Address - Phone:316-425-2419
Mailing Address - Fax:316-529-9351
Practice Address - Street 1:4505 E 47TH ST S
Practice Address - Street 2:SUITE 200
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67210-1651
Practice Address - Country:US
Practice Address - Phone:316-425-2419
Practice Address - Fax:316-529-9351
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW 3422104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker