Provider Demographics
NPI:1285187419
Name:SARACINA, ANTHONY R (PC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:R
Last Name:SARACINA
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 SHALLOW CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-8106
Mailing Address - Country:US
Mailing Address - Phone:330-268-1394
Mailing Address - Fax:
Practice Address - Street 1:5720 SHALLOW CREEK AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-8106
Practice Address - Country:US
Practice Address - Phone:330-268-1394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-23
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC-6047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health