Healthcare Provider Details

I. General information

NPI: 1265913941
Provider Name (Legal Business Name): RICHARD LEMASTER III CMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 PARK AVE W
MANSFIELD OH
44906-3706
US

IV. Provider business mailing address

680 PARK AVE W
MANSFIELD OH
44906-3706
US

V. Phone/Fax

Practice location:
  • Phone: 419-528-5993
  • Fax: 567-560-5486
Mailing address:
  • Phone: 419-528-5993
  • Fax: 567-560-5486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.168157
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: