Provider Demographics
NPI:1528184496
Name:BIELECKI, KENNETH JOSEPH (LISW-S, MSSA)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JOSEPH
Last Name:BIELECKI
Suffix:
Gender:M
Credentials:LISW-S, MSSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 GYPSY LN
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1314
Mailing Address - Country:US
Mailing Address - Phone:330-746-7929
Mailing Address - Fax:330-746-7939
Practice Address - Street 1:517 GYPSY LN
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1314
Practice Address - Country:US
Practice Address - Phone:330-746-7929
Practice Address - Fax:330-746-7939
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-0027461101YM0800X, 1041C0700X
OHI.0700113-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH101YM0800XOtherMENTAL HEALTH COUNSELOR