Provider Demographics
NPI:1093082075
Name:WOLANCZYK, ROXANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:WOLANCZYK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 GRAND STREET
Mailing Address - Street 2:B61
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:504 GRAND ST APT B61
Practice Address - Street 2:B61
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4147
Practice Address - Country:US
Practice Address - Phone:917-209-2168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0824551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical