=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962497008
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BERNADETTE A. MAKOSKY L.I.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2005
-----------------------------------------------------
Last Update Date | 11/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 337 E MAIN ST
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43130-3845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-407-3213
-----------------------------------------------------
Fax | 740-785-5189
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2020 N GLENN DR NE
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43130-9759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-407-3213
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | I.100840
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------