Provider Demographics
NPI:1831459775
Name:KUZIA, MARK J (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:KUZIA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W. OGDEN AVENUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3984
Mailing Address - Country:US
Mailing Address - Phone:630-986-0599
Mailing Address - Fax:630-986-1477
Practice Address - Street 1:501 W. OGDEN AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3984
Practice Address - Country:US
Practice Address - Phone:630-986-0599
Practice Address - Fax:630-986-1477
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008272103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical