Healthcare Provider Details

I. General information

NPI: 1952867483
Provider Name (Legal Business Name): SARA PAULINE CHEEKS LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA PAULINE MARONI

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

IV. Provider business mailing address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

V. Phone/Fax

Practice location:
  • Phone: 330-480-2040
  • Fax: 330-480-2071
Mailing address:
  • Phone: 330-480-2040
  • Fax: 330-480-2071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0026265
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.0026265
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: