MEDICARE: CALLIE LAUREN KACZMAREK 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
1	1041C0700X	Clinical Social Worker	CW015710	PA

General Provider Information

NPI Number	:	1720247331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALLIE LAUREN KACZMAREK LCSW

Provider Business Mailing Address
First Line	:	203 FAIRLAWN BLVD
Second Line	:
City	:	ZELIENOPLE
State	:	PA
Zip	:	16063-1415
Country	:	US
Telephone Number	:	724-453-0793
Fax Number	:

Provider Business Practice Location Address
First Line	:	8001 ROWAN RD
Second Line	:	SUITE 203
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-3616
Country	:	US
Telephone Number	:	724-776-3366
Fax Number	:

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

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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