Provider Demographics
NPI:1083074983
Name:WARSZAWSKI, JACOB LEW JR
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:LEW
Last Name:WARSZAWSKI
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5050
Mailing Address - Country:US
Mailing Address - Phone:740-281-1777
Mailing Address - Fax:
Practice Address - Street 1:68 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5050
Practice Address - Country:US
Practice Address - Phone:740-281-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2019-03-07
Deactivation Date:2019-02-21
Deactivation Code:
Reactivation Date:2019-03-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst