1831979384 NPI number — MR. TIMOTHY P. STIPEK BA, MSSA, LISW-SUPV

Table of content: MR. TIMOTHY P. STIPEK BA, MSSA, LISW-SUPV (NPI 1831979384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831979384 NPI number — MR. TIMOTHY P. STIPEK BA, MSSA, LISW-SUPV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STIPEK
Provider First Name:
TIMOTHY
Provider Middle Name:
P.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
BA, MSSA, LISW-SUPV
Provider Gender Code:
M

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:
1831979384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7319 GLENSIDE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLMSTED TWP
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44138-3122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-915-7547
Provider Business Mailing Address Fax Number:
216-721-0940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7319 GLENSIDE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLMSTED TWP
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44138-3122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-915-7547
Provider Business Practice Location Address Fax Number:
216-721-0940
Provider Enumeration Date:
10/03/2023

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: 171M00000X , with the licence number:  I.0005463-SUPV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: I.0005463-SUPV , 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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