Provider Demographics
NPI:1225492267
Name:VINCE - DENIRO, VANESSA (MSED, LPCC, LSW)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:VINCE - DENIRO
Suffix:
Gender:F
Credentials:MSED, LPCC, LSW
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:VINCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED, LPCC, LSW
Mailing Address - Street 1:547 NILES VIENNA RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44473-9519
Mailing Address - Country:US
Mailing Address - Phone:330-519-9539
Mailing Address - Fax:
Practice Address - Street 1:547 NILES VIENNA RD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:OH
Practice Address - Zip Code:44473-9519
Practice Address - Country:US
Practice Address - Phone:330-519-9539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1800560101Y00000X, 101YP2500X
OHS.0019920104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0275767Medicaid