Healthcare Provider Details

I. General information

NPI: 1306917414
Provider Name (Legal Business Name): ELIZABETH ANN GRYCZKO-DRAZIEN LMSW, LSW,LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 N 2ND ST SUITE 112
HARRISBURG PA
17102-2151
US

IV. Provider business mailing address

2023 N 2ND ST SUITE 112
HARRISBURG PA
17102-2151
US

V. Phone/Fax

Practice location:
  • Phone: 570-575-6971
  • Fax:
Mailing address:
  • Phone: 570-575-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW127810
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016650
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: