Provider Demographics
NPI:1467616466
Name:GREUTMAN, ANTHONY W (LSW, LICDC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:W
Last Name:GREUTMAN
Suffix:
Gender:M
Credentials:LSW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1158 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2449
Mailing Address - Country:US
Mailing Address - Phone:419-238-3434
Mailing Address - Fax:419-238-1955
Practice Address - Street 1:1158 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2449
Practice Address - Country:US
Practice Address - Phone:419-238-3434
Practice Address - Fax:419-238-1955
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011157101YA0400X
OHS0028504104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)