Provider Demographics
NPI:1275972358
Name:KANOS, JANA LEIGH (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:LEIGH
Last Name:KANOS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:JANA
Other - Middle Name:LEIGH
Other - Last Name:ALTOMARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:955 WINDHAM CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5035
Mailing Address - Country:US
Mailing Address - Phone:330-726-9570
Mailing Address - Fax:330-726-9031
Practice Address - Street 1:955 WINDHAM CT
Practice Address - Street 2:SUITE 2
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5035
Practice Address - Country:US
Practice Address - Phone:330-726-9570
Practice Address - Fax:330-726-9031
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1200651104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0174700Medicaid