Provider Demographics
NPI:1346565488
Name:RADOSTA, MARK CHARLES (MSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:CHARLES
Last Name:RADOSTA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01519-1562
Mailing Address - Country:US
Mailing Address - Phone:508-839-9745
Mailing Address - Fax:
Practice Address - Street 1:31 LAKE ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3879
Practice Address - Country:US
Practice Address - Phone:978-632-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1070471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical