Provider Demographics
NPI:1255812541
Name:CWIKLA, KENNETH ALBERT (LICSW)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ALBERT
Last Name:CWIKLA
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 READ ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-1327
Mailing Address - Country:US
Mailing Address - Phone:508-675-4635
Mailing Address - Fax:
Practice Address - Street 1:1481 READ ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-1327
Practice Address - Country:US
Practice Address - Phone:508-675-4635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101683101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor