Provider Demographics
NPI:1104363803
Name:SPARTANO, CAROL JEAN
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:SPARTANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6753 STATE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-4517
Mailing Address - Country:US
Mailing Address - Phone:440-843-5544
Mailing Address - Fax:440-843-1633
Practice Address - Street 1:4210 N JEFFERSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5639
Practice Address - Country:US
Practice Address - Phone:330-723-9615
Practice Address - Fax:330-764-8795
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator