Healthcare Provider Details

I. General information

NPI: 1447353636
Provider Name (Legal Business Name): ELAINE S SADKOWSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELAINE S SADKOWSKI REG. PLAY THERAPIST-

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 WINGED ELM CT
ST AUGUSTINE FL
32092-3547
US

IV. Provider business mailing address

58 WINGED ELM CT
ST AUGUSTINE FL
32092-3547
US

V. Phone/Fax

Practice location:
  • Phone: 904-470-0857
  • Fax:
Mailing address:
  • Phone: 904-516-7396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW5956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: