Basic Information
| Provider Information | |||||||||
| NPI: | 1801359831 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CZARNECKI | ||||||||
| FirstName: | SANDY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 631278 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452631278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003564049 | ||||||||
| FaxNumber: | 9414850519 | ||||||||
| Practice Location | |||||||||
| Address1: | 26844 TANIC DR | ||||||||
| Address2: | |||||||||
| City: | WESLEY CHAPEL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335444616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003564049 | ||||||||
| FaxNumber: | 9414850519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2019 | ||||||||
| LastUpdateDate: | 05/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-21-48504 | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.