Healthcare Provider Details

I. General information

NPI: 1578972444
Provider Name (Legal Business Name): MARIA JANE GARNER LISW,LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA JANE MARTIN LSW

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 MARTINEL DR
KENT OH
44240-4380
US

IV. Provider business mailing address

241 MARTINEL DR
KENT OH
44240-4380
US

V. Phone/Fax

Practice location:
  • Phone: 330-541-6106
  • Fax:
Mailing address:
  • Phone: 330-541-6106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1578972444
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2608406
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: