Provider Demographics
NPI:1568027357
Name:KUCMIEROWSKI, KYLE DONOVAN (LCSW)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:DONOVAN
Last Name:KUCMIEROWSKI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-2562
Mailing Address - Country:US
Mailing Address - Phone:607-734-0980
Mailing Address - Fax:607-734-0981
Practice Address - Street 1:301 W BROAD ST
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2303
Practice Address - Country:US
Practice Address - Phone:607-654-0790
Practice Address - Fax:631-350-0396
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103535-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical