Individual
GERALDINE A FEDOROWICZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
821 RAYMOND AVE STE 330, SAINT PAUL, MN 55114-1510
(612) 280-1948
Mailing address
821 RAYMOND AVE STE 330, SAINT PAUL, MN 55114-1510
(612) 245-5133
(763) 201-5859
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
21961
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881121143
—
MN
Enumeration date
05/17/2017
Last updated
03/29/2024
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