Healthcare Provider Details

I. General information

NPI: 1851059273
Provider Name (Legal Business Name): ANTHONY JOSEPH LAUDATO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 W MAIN ST
CARROLLTON OH
44615-1347
US

IV. Provider business mailing address

7790 MARKET AVE N
CANTON OH
44721-1641
US

V. Phone/Fax

Practice location:
  • Phone: 330-627-4313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: