Healthcare Provider Details

I. General information

NPI: 1700700598
Provider Name (Legal Business Name): AVERY GLASSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 FRANKLIN ST SE
WARREN OH
44483-5715
US

IV. Provider business mailing address

10417 BRIAR HILL DR
KIRTLAND OH
44094-9463
US

V. Phone/Fax

Practice location:
  • Phone: 330-372-2200
  • Fax:
Mailing address:
  • Phone: 216-978-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: