Provider Demographics
NPI:1871742221
Name:KWIATKOWSKI, LINDSAY ANN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:ANN
Last Name:KWIATKOWSKI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:LINDSAY
Other - Middle Name:ANN
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:235 SOUTH WATER STREET
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-0000
Mailing Address - Country:US
Mailing Address - Phone:304-263-8954
Mailing Address - Fax:304-263-8141
Practice Address - Street 1:235 SOUTH WATER STREET
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-0000
Practice Address - Country:US
Practice Address - Phone:304-263-8954
Practice Address - Fax:304-263-8141
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP009430891041C0700X
WVDP009430891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0023817001Medicaid