Basic Information
| Provider Information | |||||||||
| NPI: | 1518268093 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MROCZEK | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5143 W PLACITA DEL HERRERO | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857459720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208820333 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3055 N 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857192512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208820333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2010 | ||||||||
| LastUpdateDate: | 11/15/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 3012 | AZ | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.