Provider Demographics
NPI:1407975238
Name:PETRILLA, MONICA CAROL (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:CAROL
Last Name:PETRILLA
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 STARRS CENTRE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8003
Mailing Address - Country:US
Mailing Address - Phone:330-533-3102
Mailing Address - Fax:330-533-3123
Practice Address - Street 1:3821 STARRS CENTRE DR
Practice Address - Street 2:SUITE B
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8003
Practice Address - Country:US
Practice Address - Phone:330-533-3102
Practice Address - Fax:330-533-3123
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-0008340104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000503675OtherANTHEM