Provider Demographics
NPI:1952970519
Name:MLODNICKA, AGNIESZKA (PHD)
Entity Type:Individual
Prefix:DR
First Name:AGNIESZKA
Middle Name:
Last Name:MLODNICKA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6842 LINDBROOK WAY APT 19
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-4943
Mailing Address - Country:US
Mailing Address - Phone:832-715-9906
Mailing Address - Fax:
Practice Address - Street 1:6842 LINDBROOK WAY APT 19
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4943
Practice Address - Country:US
Practice Address - Phone:832-715-9906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38819103TC0700X
CA32261103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical