Provider Demographics
NPI:1760829212
Name:KULECK, JOSHUA AARON (LSW)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:AARON
Last Name:KULECK
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 CARSON ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIUM
Mailing Address - State:PA
Mailing Address - Zip Code:15834-2015
Mailing Address - Country:US
Mailing Address - Phone:814-558-8399
Mailing Address - Fax:
Practice Address - Street 1:801 SOUTH MICHAEL ST.
Practice Address - Street 2:CEN CLEAR CHILD SERVICES
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857
Practice Address - Country:US
Practice Address - Phone:814-834-9283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129710104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker