Provider Demographics
NPI:1346774783
Name:VANCANT, LARRY E (LSW)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:E
Last Name:VANCANT
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 GREEN ROAD, COTTAGE 3
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-4884
Mailing Address - Country:US
Mailing Address - Phone:330-467-7131
Mailing Address - Fax:216-591-0223
Practice Address - Street 1:4325 GREEN ROAD, COTTAGE 3
Practice Address - Street 2:
Practice Address - City:HIGHLAND HILLS
Practice Address - State:OH
Practice Address - Zip Code:44128-4884
Practice Address - Country:US
Practice Address - Phone:330-467-7131
Practice Address - Fax:216-591-0223
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0030034104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker