Provider Demographics
NPI:1104108281
Name:KURUTZ, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:KURUTZ
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 1:2201 20TH ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405
Mailing Address - Country:US
Mailing Address - Phone:408-656-3556
Mailing Address - Fax:
Practice Address - Street 1:5420 N FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:CA
Practice Address - Zip Code:90042-4118
Practice Address - Country:US
Practice Address - Phone:323-999-2492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82560106H00000X
CA67266106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist