Healthcare Provider Details

I. General information

NPI: 1306096482
Provider Name (Legal Business Name): RACHEL M CHMIELEWSKI LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL M BURDA MSW, LISW

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11369 MARKET ST
NORTH LIMA OH
44452-9782
US

IV. Provider business mailing address

1011 BOARDMAN CANFIELD RD
YOUNGSTOWN OH
44512-4226
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-9999
  • Fax: 330-757-0000
Mailing address:
  • Phone: 330-629-2888
  • Fax: 330-629-2946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-1100018
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: