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General NPI Number Information
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NPI Number | 1841414554
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Entity Type | Individual
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Provider Name | BRIAN P WLODARCZYK LISW
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Gender | Male
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 11 W MONUMENT AVE FL 7
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City | DAYTON
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State | OH
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Zip | 45402-1274
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Country | US
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Telephone | 937-461-4300
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Fax | 937-461-0443
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Provider Business Mailing Address
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Address Line | 11 W MONUMENT AVE FL 7
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City | DAYTON
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State | OH
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Zip | 45402-1274
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Country | US
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Telephone | 937-461-4300
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Fax | 937-461-0443
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I 0009966
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.0009966-SUPV
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License Number State | OH
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