Provider Demographics
NPI:1700625373
Name:KACZMARKIEWICZ, ROMA
Entity type:Individual
Prefix:
First Name:ROMA
Middle Name:
Last Name:KACZMARKIEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MAIN ST FL 3
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-2739
Mailing Address - Country:US
Mailing Address - Phone:914-327-5588
Mailing Address - Fax:
Practice Address - Street 1:140 W 71ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4018
Practice Address - Country:US
Practice Address - Phone:646-580-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health