Provider Demographics
NPI:1871698589
Name:KAZMIERCZAK, ANGELA BERNADETTE (LMSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:BERNADETTE
Last Name:KAZMIERCZAK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1653
Mailing Address - Country:US
Mailing Address - Phone:585-654-4450
Mailing Address - Fax:
Practice Address - Street 1:1100 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1653
Practice Address - Country:US
Practice Address - Phone:585-654-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker