Provider Demographics
NPI:1154952190
Name:KAZLOW, FERN (LCSW-R)
Entity type:Individual
Prefix:DR
First Name:FERN
Middle Name:
Last Name:KAZLOW
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:MILLWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10546-0602
Mailing Address - Country:US
Mailing Address - Phone:212-496-6611
Mailing Address - Fax:
Practice Address - Street 1:250 RTE 100
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3825
Practice Address - Country:US
Practice Address - Phone:212-496-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-0319101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical