Individual
BRIAN CHARLES RADZOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
205 S MAIN ST, EDWARDSVILLE, IL 62025-1921
(618) 248-2040
(618) 248-2040
Mailing address
PO BOX 101, EDWARDSVILLE, IL 62025-0101
(618) 248-2040
(618) 248-2040
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149012706
IL
1041C0700X
Clinical Social Worker
2007033648
MO
Other
Enumeration date
08/03/2008
Last updated
10/21/2016
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