Provider Demographics
NPI:1306917414
Name:GRYCZKO-DRAZIEN, ELIZABETH ANN (LMSW, LSW,LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:GRYCZKO-DRAZIEN
Suffix:
Gender:F
Credentials:LMSW, LSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 N 2ND ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17102-2151
Mailing Address - Country:US
Mailing Address - Phone:570-575-6971
Mailing Address - Fax:
Practice Address - Street 1:2023 N 2ND ST
Practice Address - Street 2:SUITE 112
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17102-2151
Practice Address - Country:US
Practice Address - Phone:570-575-6971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW127810104100000X
PACW0166501041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024474770001Medicaid