Provider Demographics
NPI:1457491284
Name:RADETSKY, SANDRA JEAN (MSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:RADETSKY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1873 SOUTH BELLAIRE STREET
Mailing Address - Street 2:1215
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4359
Mailing Address - Country:US
Mailing Address - Phone:303-722-4440
Mailing Address - Fax:303-758-7268
Practice Address - Street 1:1873 SOUTH BELLAIRE STREET
Practice Address - Street 2:1215
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4359
Practice Address - Country:US
Practice Address - Phone:303-722-4440
Practice Address - Fax:303-758-7268
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9861111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98026Medicare ID - Type Unspecified