Provider Demographics
NPI:1730234980
Name:KACZMARKIEWICZ, PENNY ELLEN (MSW,LSW)
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:ELLEN
Last Name:KACZMARKIEWICZ
Suffix:
Gender:F
Credentials:MSW,LSW
Other - Prefix:MRS
Other - First Name:PENNY
Other - Middle Name:ELLEN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW/LSW
Mailing Address - Street 1:7180 HIGHLAND DR
Mailing Address - Street 2:122D-H
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-1206
Mailing Address - Country:US
Mailing Address - Phone:412-954-5434
Mailing Address - Fax:
Practice Address - Street 1:7180 HIGHLAND DR
Practice Address - Street 2:122D-H
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-1206
Practice Address - Country:US
Practice Address - Phone:412-954-5434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW012412L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical