Healthcare Provider Details

I. General information

NPI: 1063552594
Provider Name (Legal Business Name): CYNTHIA L ROHRBAUG MSED PCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 MAHONING AVE NW
WARREN OH
44483
US

IV. Provider business mailing address

7226 N LIMA RD
POLAND OH
44514
US

V. Phone/Fax

Practice location:
  • Phone: 330-395-9563
  • Fax: 330-393-5975
Mailing address:
  • Phone: 330-757-2236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0003379
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: