Basic Information
| Provider Information | |||||||||
| NPI: | 1801942305 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DONATELLI | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5465 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198858800 | ||||||||
| FaxNumber: | 4198858600 | ||||||||
| Practice Location | |||||||||
| Address1: | 5465 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198858800 | ||||||||
| FaxNumber: | 4198858600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 0007878 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 0007878 | 01 | OH | LISW | OTHER |