Healthcare Provider Details

I. General information

NPI: 1609707504
Provider Name (Legal Business Name): LAUREN PAGLISOTTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20220 CENTER RIDGE RD STE 110
ROCKY RIVER OH
44116-3501
US

IV. Provider business mailing address

2420 LAKE AVE
ASHTABULA OH
44004-4954
US

V. Phone/Fax

Practice location:
  • Phone: 440-356-7620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.193945
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: