Healthcare Provider Details

I. General information

NPI: 1497274559
Provider Name (Legal Business Name): KAREN MARIE BUYANSKY LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2017
Last Update Date: 09/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 GOUGLER AVE
KENT OH
44240-2401
US

IV. Provider business mailing address

143 GOUGLER AVE
KENT OH
44240-2401
US

V. Phone/Fax

Practice location:
  • Phone: 330-677-4124
  • Fax:
Mailing address:
  • Phone: 330-677-4124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0008461S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: