Provider Demographics
NPI:1245478304
Name:RADECKI, NANCY ANNETTE (NANCY RADECKI)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ANNETTE
Last Name:RADECKI
Suffix:
Gender:F
Credentials:NANCY RADECKI
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ANNETTE
Other - Last Name:NATALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3537 BONSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-9635
Mailing Address - Country:US
Mailing Address - Phone:315-395-2524
Mailing Address - Fax:
Practice Address - Street 1:3537 BONSTEAD RD
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:NY
Practice Address - Zip Code:13041-9635
Practice Address - Country:US
Practice Address - Phone:315-395-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0721471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical