Provider Demographics
NPI:1679794879
Name:GORCZYNSKI, JUDEE L (MED, LSW)
Entity Type:Individual
Prefix:
First Name:JUDEE
Middle Name:L
Last Name:GORCZYNSKI
Suffix:
Gender:F
Credentials:MED, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 WYANDOTTE TRL SW
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632-9419
Mailing Address - Country:US
Mailing Address - Phone:330-877-6318
Mailing Address - Fax:
Practice Address - Street 1:520 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2218
Practice Address - Country:US
Practice Address - Phone:330-296-5552
Practice Address - Fax:330-296-6126
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-0028458101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor