BRIAN CHARLES RADZOM

EDWARDSVILLE, IL
NPI1790941300
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: IL  149012706)
Additional Taxonomies1041C0700X Social Worker, Clinical
(Licence: MO  2007033648)
Enumeration Date2008-08-03
Last Update Date2016-10-21
Business Address
-- BRIAN CHARLES RADZOM LCSW
205 S MAIN ST
EDWARDSVILLE, IL 62025-1921
Phone number: 618-248-2040
Mailing Address
-- BRIAN CHARLES RADZOM LCSW
PO BOX 101
EDWARDSVILLE, IL 62025-0101
Phone number: 618-248-2040