=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528729043
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAFAY A WALDEN II
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2022
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 165 E PARK AVE
-----------------------------------------------------
City | NILES
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44446-2352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-544-8005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 449 N WORTHINGTON ST
-----------------------------------------------------
City | YOUNGSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44510-1545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-400-2709
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------