Provider Demographics
NPI:1407153604
Name:RADOSKY, MICHAEL JASON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JASON
Last Name:RADOSKY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N MAIN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 N MAIN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-1715
Practice Address - Country:US
Practice Address - Phone:215-421-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0164431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical