Healthcare Provider Details

I. General information

NPI: 1598012858
Provider Name (Legal Business Name): ADRIA ROVNYAK LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 NORTH RD.
NILES OH
44446
US

IV. Provider business mailing address

29 NORTH RD.
NILES OH
44446
US

V. Phone/Fax

Practice location:
  • Phone: 330-652-6770
  • Fax: 330-652-2069
Mailing address:
  • Phone: 330-652-6770
  • Fax: 330-652-2069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1200514
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1700248
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: