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NPI Code Detail

MEDICARE: MRS. PATRICE M FETZER MA, LISW

MEDICARE: MRS. PATRICE M FETZER MA, 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-9751OH

General Provider Information

NPI Number : 1477528495
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PATRICE M FETZER MA, LISW
Provider Business Mailing Address
First Line : 625 CLEVELAND AVE NW
Second Line :
City : CANTON
State : OH
Zip : 44702-1805
Country : US
Telephone Number : 330-455-0374
Fax Number : 330-455-2101
Provider Business Practice Location Address
First Line : 625 CLEVELAND AVE NW
Second Line :
City : CANTON
State : OH
Zip : 44702-1805
Country : US
Telephone Number : 330-455-0374
Fax Number : 330-455-2101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2006
Last Update Date : 07/21/2022

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Directions to “ MRS. PATRICE M FETZER MA, LISW” Practice Location

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