Healthcare Provider Details

I. General information

NPI: 1962183202
Provider Name (Legal Business Name): LISA DUNKEL MSW LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15655 STATE ROUTE 170 STE A
CALCUTTA OH
43920-9672
US

IV. Provider business mailing address

49951 PANCAKE CLARKSON RD
NEGLEY OH
44441-9767
US

V. Phone/Fax

Practice location:
  • Phone: 330-386-4303
  • Fax:
Mailing address:
  • Phone: 330-942-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1903357
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: