Doctor Name: | MR. MICHAEL JASON RADOSKY |
NPI Number: | 1407153604 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | CW016443 |
Business Practice Address: | 121 N Main St Suite 108 Souderton, PA - 189641715 |
Business Phone Number: | 2154211634 |
Business Fax Number: | |
Mailing Address: | 121 N Main St, Suite 108 SOUDERTON |
State: | PA |
Postal Code: | 189641715 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 02/24/2011 |
NPI Last Update Date: | 02/24/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | CW016443 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |