Provider Demographics
NPI:1346367919
Name:LANTERMAN, JACQUELYN ANN (SW)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:ANN
Last Name:LANTERMAN
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 RESERVOIR RUN
Mailing Address - Street 2:
Mailing Address - City:MINERAL RIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:44440-9016
Mailing Address - Country:US
Mailing Address - Phone:330-652-0493
Mailing Address - Fax:
Practice Address - Street 1:1044 RESERVOIR RUN
Practice Address - Street 2:
Practice Address - City:MINERAL RIDGE
Practice Address - State:OH
Practice Address - Zip Code:44440-9016
Practice Address - Country:US
Practice Address - Phone:330-652-0493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.00225441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical