Healthcare Provider Details

I. General information

NPI: 1780330837
Provider Name (Legal Business Name): HANNAH SIMIONIDES LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 02/28/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 W MARKET ST
FAIRLAWN OH
44333-4215
US

IV. Provider business mailing address

690 LUCILLE AVE
AKRON OH
44310-2324
US

V. Phone/Fax

Practice location:
  • Phone: 234-867-5001
  • Fax:
Mailing address:
  • Phone: 234-516-1976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1801034
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: