Provider Demographics
NPI:1568795706
Name:PODRAZIK, DONNA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:PODRAZIK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 SHINGLE MILL DR
Mailing Address - Street 2:
Mailing Address - City:DRUMS
Mailing Address - State:PA
Mailing Address - Zip Code:18222-1216
Mailing Address - Country:US
Mailing Address - Phone:570-814-4847
Mailing Address - Fax:570-788-2287
Practice Address - Street 1:1096 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202
Practice Address - Country:US
Practice Address - Phone:570-814-4847
Practice Address - Fax:570-814-4847
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016677103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent