Healthcare Provider Details

I. General information

NPI: 1184261968
Provider Name (Legal Business Name): ANTHONY DURKIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2019
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 BOARDMAN CANFIELD RD STE L1
BOARDMAN OH
44512-4370
US

IV. Provider business mailing address

725 BOARDMAN CANFIELD RD STE L1
BOARDMAN OH
44512-4370
US

V. Phone/Fax

Practice location:
  • Phone: 330-330-8655
  • Fax: 330-330-8657
Mailing address:
  • Phone: 330-330-8655
  • Fax: 330-330-8657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2505493
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: