=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083415541
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIAH TOWNSEND MSW, LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2025
-----------------------------------------------------
Last Update Date | 03/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 WINDSOR DR
-----------------------------------------------------
City | CORTLAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44410-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-756-7695
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1274 OHLTOWN RD
-----------------------------------------------------
City | YOUNGSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44515-1027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-631-7555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 2309100
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------