Basic Information
Provider Information
NPI: 1346722659
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARNOVSKY
FirstName: DARBY
MiddleName: ALICIA
NamePrefix:  
NameSuffix:  
Credential: LSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10100 ELIDA RD
Address2:  
City: DELPHOS
State: OH
PostalCode: 458339056
CountryCode: US
TelephoneNumber: 4196958010
FaxNumber:  
Practice Location
Address1: 20600 CHAGRIN BLVD STE 320
Address2:  
City: CLEVELAND
State: OH
PostalCode: 441225334
CountryCode: US
TelephoneNumber: 2162957239
FaxNumber: 2162957240
Other Information
ProviderEnumerationDate: 09/04/2018
LastUpdateDate: 10/21/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/21/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000XS.1903732OHY Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


Home