Provider Demographics
NPI:1720247331
Name:KACZMAREK, CALLIE LAUREN (LCSW)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:LAUREN
Last Name:KACZMAREK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:LAUREN
Other - Last Name:HOPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 FAIRLAWN BLVD
Mailing Address - Street 2:
Mailing Address - City:ZELIENOPLE
Mailing Address - State:PA
Mailing Address - Zip Code:16063-1415
Mailing Address - Country:US
Mailing Address - Phone:724-453-0793
Mailing Address - Fax:
Practice Address - Street 1:8001 ROWAN RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-3616
Practice Address - Country:US
Practice Address - Phone:724-776-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0157101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical