Provider Demographics
NPI:1548612393
Name:KRAWCZYK, MARY KAY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KAY
Last Name:KRAWCZYK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19207 N 73RD LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5601
Mailing Address - Country:US
Mailing Address - Phone:623-628-2843
Mailing Address - Fax:855-214-0148
Practice Address - Street 1:19207 N 73RD LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5601
Practice Address - Country:US
Practice Address - Phone:623-628-2843
Practice Address - Fax:855-214-0148
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ150531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical