Provider Demographics
NPI:1306817093
Name:MCINTYRE, ROSAMOND ELAINE (LISW)
Entity Type:Individual
Prefix:MRS
First Name:ROSAMOND
Middle Name:ELAINE
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MRS
Other - First Name:ROSE
Other - Middle Name:E
Other - Last Name:MCINTYRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8916 TOPAZ TER
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-4110
Mailing Address - Country:US
Mailing Address - Phone:330-650-2874
Mailing Address - Fax:
Practice Address - Street 1:8916 TOPAZ TER
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-4110
Practice Address - Country:US
Practice Address - Phone:330-650-2874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI40201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2669607Medicaid
OHMCSW28591Medicare UPIN