Provider Demographics
NPI:1952298291
Name:GLADYSZ, TAYLOR (LCSWA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:GLADYSZ
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4832 BUTLER DR S
Mailing Address - Street 2:
Mailing Address - City:MIDWAY PARK
Mailing Address - State:NC
Mailing Address - Zip Code:28544-1361
Mailing Address - Country:US
Mailing Address - Phone:603-892-0112
Mailing Address - Fax:
Practice Address - Street 1:1903 BRAGG BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4563
Practice Address - Country:US
Practice Address - Phone:603-892-0112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0219771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical