Provider Demographics
NPI:1306969274
Name:KURTZBERG, INA RAE (MSW,LCSW-R,)
Entity type:Individual
Prefix:MS
First Name:INA
Middle Name:RAE
Last Name:KURTZBERG
Suffix:
Gender:F
Credentials:MSW,LCSW-R,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 GLEN PASTURE CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1921
Mailing Address - Country:US
Mailing Address - Phone:631-673-6111
Mailing Address - Fax:
Practice Address - Street 1:775 PARK AVE
Practice Address - Street 2:SUITE 210-1
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3976
Practice Address - Country:US
Practice Address - Phone:631-549-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2025-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR028429-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY146724OtherVALUE OPTIONS ID
NY7401019OtherGHI IDENTIFIER
NYN13751Medicare ID - Type Unspecified