Provider Demographics
NPI:1063435568
Name:JADICK, EDITH GERALDINE (LCSW)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:GERALDINE
Last Name:JADICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GERALDINE
Other - Middle Name:
Other - Last Name:JADICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1 W MARKET ST
Mailing Address - Street 2:SUITE 412
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17401-1253
Mailing Address - Country:US
Mailing Address - Phone:717-767-2873
Mailing Address - Fax:717-767-2878
Practice Address - Street 1:1 W MARKET ST
Practice Address - Street 2:SUITE 412
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17401-1253
Practice Address - Country:US
Practice Address - Phone:717-767-2873
Practice Address - Fax:717-767-2878
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC002074001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ638025Medicare ID - Type Unspecified