Provider Demographics
NPI:1598419830
Name:KUTZER, TIA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:ANN
Last Name:KUTZER
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 COURTRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1412
Mailing Address - Country:US
Mailing Address - Phone:570-902-9552
Mailing Address - Fax:
Practice Address - Street 1:69 COURTRIGHT ST
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1412
Practice Address - Country:US
Practice Address - Phone:570-902-9552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-06
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0194041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical