MEDICARE: OBSIDIAN OCD AND TRAUMA CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1255271953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OBSIDIAN OCD AND TRAUMA CENTER

Provider Business Mailing Address
First Line	:	8324 CLEVELAND AVE NW STE B
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-4832
Country	:	US
Telephone Number	:	330-575-8921
Fax Number	:

Provider Business Practice Location Address
First Line	:	8324 CLEVELAND AVE NW STE B
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-4832
Country	:	US
Telephone Number	:	330-575-8921
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	BRITTANY LASORELLA
Credential	:	LISW-S
Telephone Number	:	330-575-8921

Provider Enumeration Date	:	03/31/2026
Last Update Date	:	03/31/2026

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