Provider Demographics
NPI:1861421943
Name:KUCHINSKY, LAURA JANE (LCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JANE
Last Name:KUCHINSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 BOULEVARD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1345
Mailing Address - Country:US
Mailing Address - Phone:804-520-7210
Mailing Address - Fax:804-520-8953
Practice Address - Street 1:3660 BOULEVARD
Practice Address - Street 2:SUITE A
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1345
Practice Address - Country:US
Practice Address - Phone:804-520-7210
Practice Address - Fax:804-520-8953
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003279251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4945280Medicaid
VA086363Medicaid
VA106588Medicaid
VA526861Medicare UPIN