Provider Demographics
NPI:1467103473
Name:WISHNICK KAMINSKY, BETH D I
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:D
Last Name:WISHNICK KAMINSKY
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1147
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19058-1147
Mailing Address - Country:US
Mailing Address - Phone:215-337-3933
Mailing Address - Fax:
Practice Address - Street 1:11 MAPLE DR
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2206
Practice Address - Country:US
Practice Address - Phone:610-213-3519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical