Basic Information
| Provider Information | |||||||||
| NPI: | 1578645883 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAWROCKI | ||||||||
| FirstName: | MADELYN | ||||||||
| MiddleName: | ABRAM | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2120 EXCHANGE ST | ||||||||
| Address2: | STE 301 | ||||||||
| City: | ASTORIA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033250241 | ||||||||
| FaxNumber: | 5033258483 | ||||||||
| Practice Location | |||||||||
| Address1: | 2120 EXCHANGE ST | ||||||||
| Address2: | STE 301 | ||||||||
| City: | ASTORIA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033250241 | ||||||||
| FaxNumber: | 5033258483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 05/04/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CW015118 | PA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 001520146 | 01 | PA | HIGHMARK PIN | OTHER |