Provider Demographics
NPI:1528540648
Name:KIETZMANN, KATIE MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:KIETZMANN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:BIASINI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MARRIED NAME
Mailing Address - Street 1:932 STATE HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-6929
Mailing Address - Country:US
Mailing Address - Phone:518-332-7816
Mailing Address - Fax:
Practice Address - Street 1:173 LAKE HILL RD
Practice Address - Street 2:
Practice Address - City:BURNT HILLS
Practice Address - State:NY
Practice Address - Zip Code:12027-9440
Practice Address - Country:US
Practice Address - Phone:518-399-9141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095953104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker