Provider Demographics
NPI:1467010710
Name:KWAK, JOSEPH IV (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:KWAK
Suffix:IV
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E SWEDESFORD RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1458
Mailing Address - Country:US
Mailing Address - Phone:484-798-9977
Mailing Address - Fax:
Practice Address - Street 1:150 E SWEDESFORD RD STE 2A
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1458
Practice Address - Country:US
Practice Address - Phone:484-798-9977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-02
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0212661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty