Provider Demographics
NPI:1093785339
Name:GUMIENNY, KATHLEEN KLEMER (LCSW C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:KLEMER
Last Name:GUMIENNY
Suffix:
Gender:F
Credentials:LCSW C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 PIERCE ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5512
Mailing Address - Country:US
Mailing Address - Phone:410-991-2077
Mailing Address - Fax:570-696-1526
Practice Address - Street 1:480 PIERCE ST
Practice Address - Street 2:#305
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5512
Practice Address - Country:US
Practice Address - Phone:410-991-2077
Practice Address - Fax:570-696-1526
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07971104100000X
PACWO157751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker