Provider Demographics
NPI:1063772549
Name:JUSZCZAK, KARA M (LMSW)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:M
Last Name:JUSZCZAK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:M
Other - Last Name:DITUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:66 CHRISTINA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHILI
Mailing Address - State:NY
Mailing Address - Zip Code:14514-9756
Mailing Address - Country:US
Mailing Address - Phone:585-472-1819
Mailing Address - Fax:
Practice Address - Street 1:175 HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1059
Practice Address - Country:US
Practice Address - Phone:585-546-1960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0715961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical