Provider Demographics
NPI:1821219643
Name:RADKOWSKY, MICHAEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:RADKOWSKY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 CONNECTICUT AVENUE, NW
Mailing Address - Street 2:STE 439
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2549
Mailing Address - Country:US
Mailing Address - Phone:202-234-3278
Mailing Address - Fax:
Practice Address - Street 1:3000 CONNECTICUT AVENUE, NW
Practice Address - Street 2:SUITE 137
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2549
Practice Address - Country:US
Practice Address - Phone:202-234-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1000053103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC52-2109946OtherTAX ID
DC1000053OtherPSYCHOLOGY LICENSE