Healthcare Provider Details

I. General information

NPI: 1548698624
Provider Name (Legal Business Name): NICOLE LYNN FRIEND LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2013
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 S MAIN ST
COVENTRY TWP OH
44319-3028
US

IV. Provider business mailing address

3445 S MAIN ST
COVENTRY TWP OH
44319-3028
US

V. Phone/Fax

Practice location:
  • Phone: 330-644-4095
  • Fax: 330-645-2031
Mailing address:
  • Phone: 330-644-4095
  • Fax: 330-645-2031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1700623
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: