Healthcare Provider Details

I. General information

NPI: 1508984352
Provider Name (Legal Business Name): MARY DIEHL DEUCHER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY MARGARET DEUCHER LISW

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 S MAIN ST SUITE 302
OBERLIN OH
44074-1677
US

IV. Provider business mailing address

14913 GARFIELD RD SUEITE 302
WAKEMAN OH
44889-9584
US

V. Phone/Fax

Practice location:
  • Phone: 440-775-7171
  • Fax: 440-774-2339
Mailing address:
  • Phone: 440-965-4775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI. 0009484
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: