Provider Demographics
NPI:1710605183
Name:STRAMAGLIA, KANETRA SCOTT
Entity Type:Individual
Prefix:
First Name:KANETRA
Middle Name:SCOTT
Last Name:STRAMAGLIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 BLAISDELL RD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7885
Mailing Address - Country:US
Mailing Address - Phone:803-487-9000
Mailing Address - Fax:
Practice Address - Street 1:3222 BLAISDELL RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-7885
Practice Address - Country:US
Practice Address - Phone:803-487-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0070751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical