Provider Demographics
NPI:1518268093
Name:MROCZEK, KENNETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:MROCZEK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5143 W PLACITA DEL HERRERO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-9720
Mailing Address - Country:US
Mailing Address - Phone:520-882-0333
Mailing Address - Fax:
Practice Address - Street 1:3055 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2512
Practice Address - Country:US
Practice Address - Phone:520-882-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3012103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist