Provider Demographics
NPI:1285220319
Name:AUDREY TYSZKA, LCSW, PLLC
Entity Type:Organization
Organization Name:AUDREY TYSZKA, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:GINNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RENEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-956-0935
Mailing Address - Street 1:44 OSWEGO ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 OSWEGO ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-2471
Practice Address - Country:US
Practice Address - Phone:315-703-2839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-13
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty