Healthcare Provider Details

I. General information

NPI: 1497326458
Provider Name (Legal Business Name): JOSEPH WILLIAM GUMINA CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 SILVER MAPLE WAY
LORAIN OH
44053-2380
US

IV. Provider business mailing address

2305 RUSSELL AVE
PARMA OH
44134-1552
US

V. Phone/Fax

Practice location:
  • Phone: 440-830-3407
  • Fax:
Mailing address:
  • Phone: 440-444-8167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCD.176201
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: