1174764971 NPI number — MRS. CASSIE LYNN DIRENZO M.S.W., L.I.S.W.

Table of content: MRS. CASSIE LYNN DIRENZO M.S.W., L.I.S.W. (NPI 1174764971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174764971 NPI number — MRS. CASSIE LYNN DIRENZO M.S.W., L.I.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIRENZO
Provider First Name:
CASSIE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.W., L.I.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174764971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1203 FAIRMONT STREET
Provider Second Line Business Mailing Address:
PATHWAY COUNSELING CENTER, LLC
Provider Business Mailing Address City Name:
EAST LIVERPOOL
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-383-2961
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16239 SAINT CLAIR AVE
Provider Second Line Business Practice Location Address:
PATHWAY COUNSELING CENTER, LLC
Provider Business Practice Location Address City Name:
EAST LIVERPOOL
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43920-9449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-386-4008
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I0700107 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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