Provider Demographics
NPI:1467078592
Name:WASNICK, LAURA (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WASNICK
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3732 FISHCREEK RD # 946
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4304
Mailing Address - Country:US
Mailing Address - Phone:216-389-4098
Mailing Address - Fax:
Practice Address - Street 1:26777 LORAIN RD STE 310
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3228
Practice Address - Country:US
Practice Address - Phone:216-389-4098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1802502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker