Provider Demographics
NPI:1841414554
Name:WLODARCZYK, BRIAN P (LISW)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:P
Last Name:WLODARCZYK
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 W MONUMENT AVE FL 7
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-1274
Mailing Address - Country:US
Mailing Address - Phone:937-461-4300
Mailing Address - Fax:937-461-0443
Practice Address - Street 1:11 W MONUMENT AVE FL 7
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1274
Practice Address - Country:US
Practice Address - Phone:937-461-4300
Practice Address - Fax:937-461-0443
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00099661041C0700X
OHI.0009966-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical