Healthcare Provider Details

I. General information

NPI: 1710616479
Provider Name (Legal Business Name): VILMARY KAUSITS LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11369 MARKET ST
NORTH LIMA OH
44452-9782
US

IV. Provider business mailing address

731 PENHALE AVE
CAMPBELL OH
44405-1531
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-9999
  • Fax: 234-759-3971
Mailing address:
  • Phone: 330-207-2295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2405943
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: