MEDICARE: AGNIESZKA KOLODZIEJ

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	101YM0800X	Mental Health Counselor	LCSW00001274	KY

General Provider Information

NPI Number	:	1831038025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGNIESZKA KOLODZIEJ

Provider Business Mailing Address
First Line	:	4101 TATES CREEK CENTRE DR STE 150
Second Line	:	PMB 279
City	:	LEXINGTON
State	:	KY
Zip	:	40517
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 TATES CREEK CENTRE DR STE 150
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-3096
Country	:	US
Telephone Number	:	917-287-5451
Fax Number	:

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

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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