Provider Demographics
NPI:1316146491
Name:RADZIESKI, SHAUNA
Entity type:Individual
Prefix:MS
First Name:SHAUNA
Middle Name:
Last Name:RADZIESKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S 4TH ST
Mailing Address - Street 2:SUITE 471
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1570
Mailing Address - Country:US
Mailing Address - Phone:267-861-3685
Mailing Address - Fax:
Practice Address - Street 1:525 S 4TH ST
Practice Address - Street 2:SUITE 471
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1570
Practice Address - Country:US
Practice Address - Phone:267-861-3685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1250811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical