Basic Information
| Provider Information | |||||||||
| NPI: | 1588259808 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIVACEK | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | V. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 SAND CREEK RD | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122051825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183129730 | ||||||||
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| Practice Location | |||||||||
| Address1: | 115 FALL ST | ||||||||
| Address2: | |||||||||
| City: | SENECA FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 131481498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155155183 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2021 | ||||||||
| LastUpdateDate: | 03/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 111327-01 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.