Healthcare Provider Details

I. General information

NPI: 1265460042
Provider Name (Legal Business Name): BARBARA G HOFELICH LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 05/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 NORTHLAND DR
MEDINA OH
44256-3441
US

IV. Provider business mailing address

4483 GREAT SMOKEY CIR
MEDINA OH
44256-7126
US

V. Phone/Fax

Practice location:
  • Phone: 330-723-9600
  • Fax:
Mailing address:
  • Phone: 330-723-5833
  • Fax: 330-723-5833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI10146
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: