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General NPI Number Information
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NPI Number | 1861923807
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Entity Type | Individual
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Provider Name | LISA PETRARCA-GAMIDO LICDC
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Gender | Female
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 4161 BRIDGEWATER PKWY
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City | STOW
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State | OH
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Zip | 44224-6191
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Country | US
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Telephone | 330-865-4644
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Fax | 330-865-4641
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Provider Business Mailing Address
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Address Line | 3581 REDWILLOW WAY
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City | NORTON
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State | OH
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Zip | 44203-4544
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Country | US
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Telephone | 303-388-5757
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LICDC.161387
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License Number State | OH
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