Provider Demographics
NPI:1497868004
Name:ENGELHARDT, GARY JAMES (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:JAMES
Last Name:ENGELHARDT
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N BEVER ST
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2909
Mailing Address - Country:US
Mailing Address - Phone:330-345-7914
Mailing Address - Fax:
Practice Address - Street 1:124 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-4808
Practice Address - Country:US
Practice Address - Phone:330-262-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00093731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical