Provider Demographics
NPI:1619032125
Name:PIEKARSKI, KATHRYN BRIDGET (MS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:BRIDGET
Last Name:PIEKARSKI
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7175
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33807-7175
Mailing Address - Country:US
Mailing Address - Phone:863-640-3407
Mailing Address - Fax:863-646-1847
Practice Address - Street 1:1700 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2263
Practice Address - Country:US
Practice Address - Phone:863-640-3407
Practice Address - Fax:863-646-1847
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5220101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health