Provider Demographics
NPI:1467420281
Name:GWOZDZ, KATHERINE A (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:A
Last Name:GWOZDZ
Suffix:
Gender:F
Credentials:LICSW
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 226
Mailing Address - Street 2:190 HOWLAND AVE. (REAR)
Mailing Address - City:ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01220-0226
Mailing Address - Country:US
Mailing Address - Phone:413-743-0100
Mailing Address - Fax:413-743-0110
Practice Address - Street 1:190 HOWLAND AVE REAR
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01220-1124
Practice Address - Country:US
Practice Address - Phone:413-743-0100
Practice Address - Fax:413-743-0110
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1120841041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO8546OtherBCBSMA
MA000000031167OtherBMC HEALTHNET PLAN
MAGW-P23779Medicare ID - Type UnspecifiedPART B
MAGW-P23779Medicare UPIN