Provider Demographics
NPI:1932264348
Name:NEDZELA, CAROLE (ACSW, BCD)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:
Last Name:NEDZELA
Suffix:
Gender:F
Credentials:ACSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14031 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3558
Mailing Address - Country:US
Mailing Address - Phone:718-762-0918
Mailing Address - Fax:718-762-2005
Practice Address - Street 1:14031 OAK AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3558
Practice Address - Country:US
Practice Address - Phone:718-762-0918
Practice Address - Fax:718-762-2005
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0183611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY26581Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER