Provider Information for 1972664803
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KEVIN M HAZUCHA LCSW
Sex: Male
NPI: 1972664803
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1972664803 | ||||||||
| Enumeration Date | 2006-12-13 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3 SUMTER RD AIRMONT, NY 10952-4134 United States Phone: 845-368-1567 | Fax: | ||||||||
| Primary Practice Address | 260 E 188TH ST BRONX, NY 10458-5302 United States Phone: 718-960-0449 | Fax: | ||||||||
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