Provider Demographics
NPI:1346496882
Name:HARVEY, GINNY (LISW)
Entity Type:Individual
Prefix:
First Name:GINNY
Middle Name:
Last Name:HARVEY
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 1:5788 RIDGE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-3162
Mailing Address - Country:US
Mailing Address - Phone:419-202-6459
Mailing Address - Fax:
Practice Address - Street 1:5788 RIDGE ROAD, SUITE 2
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-3126
Practice Address - Country:US
Practice Address - Phone:419-202-6459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 0800570104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicaid