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NPI Code Detail

MEDICARE: DR. MATTHEW ANDREW KAWIAK D.MIN., LCSW

MEDICARE: DR. MATTHEW ANDREW KAWIAK D.MIN., LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerR038598-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1R038598-1OTHERNYLCSW

General Provider Information

NPI Number : 1457374167
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW ANDREW KAWIAK D.MIN., LCSW
Provider Business Mailing Address
First Line : 625 PANORAMA TRAIL
Second Line : BLDG 1
City : ROCHESTER
State : NY
Zip : 14625
Country : US
Telephone Number : 585-586-8650
Fax Number : 585-387-0516
Provider Business Practice Location Address
First Line : 625 PANORAMA TRL
Second Line : BLDG 1
City : ROCHESTER
State : NY
Zip : 14625-2404
Country : US
Telephone Number : 585-586-8650
Fax Number : 585-387-0516
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 07/08/2007

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