Provider Demographics
NPI:1356807903
Name:KICZKOWSKI, URSULA HELENE (LMSW)
Entity type:Individual
Prefix:MS
First Name:URSULA
Middle Name:HELENE
Last Name:KICZKOWSKI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 OAK ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1326
Mailing Address - Country:US
Mailing Address - Phone:413-459-6264
Mailing Address - Fax:
Practice Address - Street 1:25 GRAVES AVE
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3293
Practice Address - Country:US
Practice Address - Phone:413-585-8390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083677-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker