Provider Demographics
NPI:1356411052
Name:BADACZEWSKI, LAWRENCE (LSW, MSW)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:BADACZEWSKI
Suffix:
Gender:M
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 EXECUTIVE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6406
Mailing Address - Country:US
Mailing Address - Phone:724-776-5690
Mailing Address - Fax:724-776-5611
Practice Address - Street 1:215 EXECUTIVE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6406
Practice Address - Country:US
Practice Address - Phone:724-776-5690
Practice Address - Fax:724-776-5611
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW-004-048-E104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA532705Medicare UPIN