Provider Demographics
NPI:1861663080
Name:BIELAWSKI, EDWARD LEONARD (MA)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:LEONARD
Last Name:BIELAWSKI
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:OLYPHANT
Mailing Address - State:PA
Mailing Address - Zip Code:18447-2161
Mailing Address - Country:US
Mailing Address - Phone:570-489-4882
Mailing Address - Fax:
Practice Address - Street 1:606 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447-2161
Practice Address - Country:US
Practice Address - Phone:570-489-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-003649-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist