Provider Demographics
NPI:1134148695
Name:DRAZIEN, TODD MITCHELL (LSW)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:MITCHELL
Last Name:DRAZIEN
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1917
Mailing Address - Country:US
Mailing Address - Phone:717-919-8831
Mailing Address - Fax:
Practice Address - Street 1:2209 FOREST HILLS DR
Practice Address - Street 2:SUITE 19
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1095
Practice Address - Country:US
Practice Address - Phone:717-540-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW124662101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health