Healthcare Provider Details

I. General information

NPI: 1386193001
Provider Name (Legal Business Name): KRISTINA E DUNDORE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA E RUTKOWSKI

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 NEW HOLLAND AVE
LANCASTER PA
17602-2137
US

IV. Provider business mailing address

320 HIGHLAND DRIVE PO BOX 597
MOUNTVILLE PA
17554-0597
US

V. Phone/Fax

Practice location:
  • Phone: 717-390-0353
  • Fax: 717-390-1812
Mailing address:
  • Phone: 570-323-6944
  • Fax: 570-323-4529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW132765
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW020567
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: