Healthcare Provider Details

I. General information

NPI: 1235754052
Provider Name (Legal Business Name): ADAM LONARDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 BOARDMAN CANFIELD RD STE C4
YOUNGSTOWN OH
44512-4367
US

IV. Provider business mailing address

9495 HARVARD BLVD
YOUNGSTOWN OH
44514-3369
US

V. Phone/Fax

Practice location:
  • Phone: 855-292-9778
  • Fax:
Mailing address:
  • Phone: 855-292-9778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number173700
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number173700
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: