Provider Demographics
NPI:1508122888
Name:KRYSZKIEWICZ, REBECCA CARRIE MICHELE (LSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:CARRIE MICHELE
Last Name:KRYSZKIEWICZ
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:BUILDING 673
Mailing Address - Street 2:STOP 129
Mailing Address - City:SCHOFIELD BARRACKS
Mailing Address - State:HI
Mailing Address - Zip Code:96857-5000
Mailing Address - Country:US
Mailing Address - Phone:808-433-9011
Mailing Address - Fax:808-433-8701
Practice Address - Street 1:BUILDING 673
Practice Address - Street 2:STOP 129
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96857-5000
Practice Address - Country:US
Practice Address - Phone:808-433-9011
Practice Address - Fax:808-433-8701
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker