Provider Demographics
NPI:1992289623
Name:NANCY A RADECKI LCSW PC
Entity type:Organization
Organization Name:NANCY A RADECKI LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RADECKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:315-530-7986
Mailing Address - Street 1:290 ELWOOD DAVIS RD STE 301
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-2127
Mailing Address - Country:US
Mailing Address - Phone:315-530-7986
Mailing Address - Fax:315-934-4501
Practice Address - Street 1:290 ELWOOD DAVIS RD STE 301
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-2127
Practice Address - Country:US
Practice Address - Phone:315-530-7986
Practice Address - Fax:315-934-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty