Provider Demographics
NPI:1972623106
Name:KUNTZ, GARY PATRICK (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:PATRICK
Last Name:KUNTZ
Suffix:
Gender:M
Credentials:MSW, LICSW
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 491
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01096-0491
Mailing Address - Country:US
Mailing Address - Phone:413-268-2626
Mailing Address - Fax:
Practice Address - Street 1:30 PETTICOAT HILL ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MA
Practice Address - Zip Code:01096-0491
Practice Address - Country:US
Practice Address - Phone:413-268-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1139251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical