Provider Demographics
NPI:1487954459
Name:RADKO, DAVID S (MS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:S
Last Name:RADKO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2486 CECIL WEBB PL
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-8337
Mailing Address - Country:US
Mailing Address - Phone:386-842-2208
Mailing Address - Fax:386-842-5691
Practice Address - Street 1:2486 CECIL WEBB PL
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060-8337
Practice Address - Country:US
Practice Address - Phone:386-842-2208
Practice Address - Fax:386-842-5691
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health