Provider Demographics
NPI:1942278338
Name:KUCIRKA, AMY J (PSYD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:KUCIRKA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 LANCASTER BLVD
Mailing Address - Street 2:PO BOX 2028
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055
Mailing Address - Country:US
Mailing Address - Phone:717-691-3755
Mailing Address - Fax:717-691-3834
Practice Address - Street 1:175 LANCASTER BLVD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055
Practice Address - Country:US
Practice Address - Phone:717-691-3755
Practice Address - Fax:717-691-3834
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015142L103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA051687Medicare ID - Type Unspecified
P41680Medicare UPIN