MEDICARE: DR. KENNETH MROCZEK PSYD

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
1	103T00000X	Psychologist	3012	AZ

General Provider Information

NPI Number	:	1518268093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH MROCZEK PSYD

Provider Business Mailing Address
First Line	:	5143 W PLACITA DEL HERRERO
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-9720
Country	:	US
Telephone Number	:	520-882-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	3055 N 1ST AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-2512
Country	:	US
Telephone Number	:	520-882-0333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2010
Last Update Date	:	11/15/2010

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