Healthcare Provider Details

I. General information

NPI: 1285367615
Provider Name (Legal Business Name): DANIEL S. LIEZERT C.D.C.A., PRS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2022
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 S PORTAGE PATH
AKRON OH
44320-2326
US

IV. Provider business mailing address

2534 CHRISTENSEN AVE
AKRON OH
44314-3543
US

V. Phone/Fax

Practice location:
  • Phone: 330-315-4914
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.181820
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.003366
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCDCA.185627
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: