Provider Demographics
NPI:1821785718
Name:PAWELCZYK, DEIDRA
Entity type:Individual
Prefix:
First Name:DEIDRA
Middle Name:
Last Name:PAWELCZYK
Suffix:
Gender:
Credentials:
Other - Prefix:MS
Other - First Name:DEIDRA
Other - Middle Name:ELLEN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:444 MAGOTHY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122
Mailing Address - Country:US
Mailing Address - Phone:240-454-4149
Mailing Address - Fax:
Practice Address - Street 1:444 MAGOTHY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122
Practice Address - Country:US
Practice Address - Phone:240-454-4149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician