Provider Demographics
NPI:1295229490
Name:REA, COREY (LISW)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:REA
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 ORCHARDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-5836
Mailing Address - Country:US
Mailing Address - Phone:855-437-6779
Mailing Address - Fax:330-840-7496
Practice Address - Street 1:151 ORCHARDVIEW RD
Practice Address - Street 2:
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-5836
Practice Address - Country:US
Practice Address - Phone:855-437-6779
Practice Address - Fax:330-840-7496
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.18009401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical