Provider Demographics
NPI:1447344619
Name:PAWLACZYK, KATHERINE M (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:M
Last Name:PAWLACZYK
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 ENGLISH RD
Mailing Address - Street 2:STE 5
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-1600
Mailing Address - Country:US
Mailing Address - Phone:585-425-8559
Mailing Address - Fax:
Practice Address - Street 1:39 DUNCAN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1017
Practice Address - Country:US
Practice Address - Phone:585-786-0190
Practice Address - Fax:585-786-0196
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0748821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000528721001OtherBC/BSWNY