Individual
KASHMIR KUSTANOWITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1100 GLENWOOD AVE, MINNEAPOLIS, MN 55405-1430
(612) 871-1454
Mailing address
1100 GLENWOOD AVE, MINNEAPOLIS, MN 55405-1430
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
29674
MN
1041C0700X
Clinical Social Worker
79808
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891103255
—
CA
Enumeration date
07/30/2014
Last updated
05/03/2021
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