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NPI Code Detail

MEDICARE: MISS MARY KENT LCDCIII, QMHS

MEDICARE: MISS MARY KENT LCDCIII, QMHS
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
1171M00000XCase Manager/Care Coordinator
2172V00000XCommunity Health WorkerOH
3101YA0400XAddiction (Substance Use Disorder) CounselorLCDCIII.161641OH

General Provider Information

NPI Number : 1932613247
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MARY KENT LCDCIII, QMHS
Provider Business Mailing Address
First Line : 1735 S HAWKINS AVE STE A
Second Line :
City : AKRON
State : OH
Zip : 44320-3902
Country : US
Telephone Number : 330-867-5400
Fax Number : 330-869-8263
Provider Business Practice Location Address
First Line : 1735 S HAWKINS AVE
Second Line :
City : AKRON
State : OH
Zip : 44320-3902
Country : US
Telephone Number : 330-867-5400
Fax Number : 330-869-8263
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2017
Last Update Date : 06/29/2023

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