MEDICARE: CHARLOTTE A GRODZKI LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC00002900	NJ

General Provider Information

NPI Number	:	1407897713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE A GRODZKI LCSW

Provider Business Mailing Address
First Line	:	37 MEADOW LAKES 04
Second Line	:
City	:	EAST WINDSOR
State	:	NJ
Zip	:	08520
Country	:	US
Telephone Number	:	609-426-0321
Fax Number	:

Provider Business Practice Location Address
First Line	:	1253 LAWRENCE RD
Second Line	:
City	:	LAWRENCEVILLE
State	:	NJ
Zip	:	08648-3545
Country	:	US
Telephone Number	:	609-426-0321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	04/14/2017

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