Provider Demographics
NPI:1134663990
Name:KACZMAREK, JENNIFER (LSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KACZMAREK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MOUNTAINVIEW LANE
Mailing Address - Street 2:
Mailing Address - City:SCHWENSKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19473
Mailing Address - Country:US
Mailing Address - Phone:570-862-9488
Mailing Address - Fax:
Practice Address - Street 1:41 MOUNTAINVIEW LANE
Practice Address - Street 2:
Practice Address - City:SCHWENSKVILLE
Practice Address - State:PA
Practice Address - Zip Code:19473
Practice Address - Country:US
Practice Address - Phone:570-862-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW012723L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker