Provider Demographics
NPI:1063072577
Name:KACZMAREK, JILL MARIE BUSOLITS
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE BUSOLITS
Last Name:KACZMAREK
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:BUSOLITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1411 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109-1505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1411 UNION BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-1505
Practice Address - Country:US
Practice Address - Phone:610-433-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136172104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker