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NPI Code Detail

MEDICARE: CELISA MARIE HARDESTY LISW

MEDICARE: CELISA MARIE HARDESTY LISW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI.1901425-SUPVOH
2104100000XSocial WorkerI1901425OH

General Provider Information

NPI Number : 1164807442
Entity Type Code : Individual
Provider Name (Legal Business Name) : CELISA MARIE HARDESTY LISW
Provider Business Mailing Address
First Line : 1400 S ARLINGTON ST UNIT 38
Second Line :
City : AKRON
State : OH
Zip : 44306-3771
Country : US
Telephone Number : 888-975-9188
Fax Number : 330-564-9977
Provider Business Practice Location Address
First Line : 2737 YOUNGSTOWN RD SE
Second Line :
City : WARREN
State : OH
Zip : 44484-5002
Country : US
Telephone Number : 330-369-8022
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2015
Last Update Date : 09/05/2025

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