MEDICARE: NORTH OLMSTED FAMILY COUNSELING SVC LLC

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
1	101Y00000X	Counselor	I0005085	OH
2	104100000X	Social Worker	I0005085	OH

General Provider Information

NPI Number	:	1962557132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH OLMSTED FAMILY COUNSELING SVC LLC

Provider Business Mailing Address
First Line	:	26777 LORAIN RD
Second Line	:	#308
City	:	NORTH OLMSTEAD
State	:	OH
Zip	:	44070
Country	:	US
Telephone Number	:	440-779-9565
Fax Number	:	440-779-0437

Provider Business Practice Location Address
First Line	:	26777 LORAIN RD
Second Line	:	#308
City	:	NORTH OLMSTEAD
State	:	OH
Zip	:	44070
Country	:	US
Telephone Number	:	440-779-9565
Fax Number	:	440-779-0437

Authorized Official
Title or Position	:	CO OWNER THERAPIST
Name	:	DIANE J MILLER MANDELL
Credential	:	MSCA CISW
Telephone Number	:	513-770-3231

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	09/11/2025

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