Provider Demographics
NPI:1821562554
Name:DE NARDO-KACZMAREK, AMY LYNN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:DE NARDO-KACZMAREK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CARAWAY CT
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8340
Mailing Address - Country:US
Mailing Address - Phone:732-337-9797
Mailing Address - Fax:
Practice Address - Street 1:4575 STUART ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29207-5701
Practice Address - Country:US
Practice Address - Phone:732-337-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5602101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional