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NPI Code Detail

MEDICARE: MS. ROSEMARIE STOFKO LCDCIII

MEDICARE: MS. ROSEMARIE STOFKO LCDCIII
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.163909OH
2101YA0400XAddiction (Substance Use Disorder) Counselor161789OH

General Provider Information

NPI Number : 1518484997
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ROSEMARIE STOFKO LCDCIII
Provider Business Mailing Address
First Line : 2151 RUSH BLVD
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44507-1535
Country : US
Telephone Number : 330-744-1181
Fax Number : 330-740-2849
Provider Business Practice Location Address
First Line : 4930 ENTERPRISE DR NW
Second Line :
City : WARREN
State : OH
Zip : 44481-8706
Country : US
Telephone Number : 330-787-0955
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2017
Last Update Date : 05/09/2022

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