Provider Demographics
NPI:1073847315
Name:EBERSOLE, RACHEL ANN (LISW)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:ANN
Last Name:EBERSOLE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANN
Other - Last Name:MEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:434 EASTLAND RD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1217
Mailing Address - Country:US
Mailing Address - Phone:440-260-8300
Mailing Address - Fax:440-260-8305
Practice Address - Street 1:2173 N RIDGE RD E STE E
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-3400
Practice Address - Country:US
Practice Address - Phone:440-260-6108
Practice Address - Fax:440-282-3400
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0900531104100000X
OHI.12004711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker