| Audrey Tyszka, Lcsw, Pllc | |
|
44 Oswego St Baldwinsville NY 13027-2471 | |
| (315) 703-2839 | |
| Not Available |
| Full Name | Audrey Tyszka, Lcsw, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 44 Oswego St, Baldwinsville, New York |
| Authorized Official Name and Position | Ginny Reneau (INSURANCE CONSULTANT) |
| Authorized Official Contact | 3159560935 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Audrey Tyszka, Lcsw, Pllc 44 Oswego St Baldwinsville NY 13027-2471 Ph: () - | Audrey Tyszka, Lcsw, Pllc 44 Oswego St Baldwinsville NY 13027-2471 Ph: (315) 703-2839 |
| NPI Number | 1285220319 |
|---|---|
| Provider Enumeration Date | 12/13/2020 |
| Last Update Date | 12/06/2021 |
| Certification Date | 12/06/2021 |
| Medicare PECOS PAC ID | 8123429321 |
|---|---|
| Medicare Enrollment ID | O20210625000506 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285220319 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Audrey I Tyszka |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184976805 PECOS PAC ID: 4385911007 Enrollment ID: I20170601000791 |
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