Provider Demographics
NPI:1467688028
Name:IWASZKIW, TAMARA A (LISW-S)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:A
Last Name:IWASZKIW
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 1:347 MIDWAY BLVD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035
Mailing Address - Country:US
Mailing Address - Phone:440-324-5701
Mailing Address - Fax:440-324-9978
Practice Address - Street 1:347 MIDWAY BLVD
Practice Address - Street 2:SUITE #200
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035
Practice Address - Country:US
Practice Address - Phone:440-324-5701
Practice Address - Fax:440-324-9978
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0007501-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical