Provider Demographics
NPI:1598218117
Name:JEDLICKA, CAROLINE MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MARIE
Last Name:JEDLICKA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 AVENUE OF THE AMERICAS
Mailing Address - Street 2:ATT'N: CREDENTIALING
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2022
Mailing Address - Country:US
Mailing Address - Phone:212-633-9300
Mailing Address - Fax:
Practice Address - Street 1:2090 ADAM CLAYTON POWELL JR BLVD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4990
Practice Address - Country:US
Practice Address - Phone:212-633-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-31
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093085104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker