Organization
AMANDA GABRIELLE KACENA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA GABRIELLE KACENA LCSW (OWNER)
(312) 590-7140
Entity
Organization
Contact information
Practice address
2005 VALPARAISO ST STE 106, VALPARAISO, IN 46383-3330
(312) 590-7140
Mailing address
4101 BRENTWOOD DR, VALPARAISO, IN 46383-1373
(312) 590-7140
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
39001619A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39001619A
STATE LICENSE
IN
Enumeration date
10/17/2017
Last updated
10/17/2017
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