Provider Demographics
NPI:1457798175
Name:KWIATKOWSKI, AMY T (LSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:T
Last Name:KWIATKOWSKI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3427 KRAMER ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-3704
Mailing Address - Country:US
Mailing Address - Phone:717-991-3582
Mailing Address - Fax:
Practice Address - Street 1:3427 KRAMER ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-3704
Practice Address - Country:US
Practice Address - Phone:717-991-3582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1254761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical