Provider Demographics
NPI:1437919131
Name:KURZ, JACLYN A (LMSW)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:A
Last Name:KURZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:MARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:35 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11724-1409
Mailing Address - Country:US
Mailing Address - Phone:516-840-2143
Mailing Address - Fax:
Practice Address - Street 1:35 SPRING ST
Practice Address - Street 2:
Practice Address - City:COLD SPRING HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11724-1409
Practice Address - Country:US
Practice Address - Phone:516-840-2143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100742-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker