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General NPI Number Information
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NPI Number | 1851867964
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Entity Type | Individual
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Provider Name | LISBETH JUSTICE LSW
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Gender | Female
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Dates
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Enumeration Date | 10/16/2018
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Last Update Date | 10/16/2018
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Provider Practice Location Address
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Address Line | 1488 W LIBERTY ST
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City | HUBBARD
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State | OH
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Zip | 44425-3309
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Country | US
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Telephone | 330-707-4701
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Fax |
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Provider Business Mailing Address
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Address Line | 211 BRADY ST
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City | KENT
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State | OH
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Zip | 44240-2503
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Country | US
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Telephone | 330-673-5839
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.0015054
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License Number State | OH
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