Provider Demographics
NPI:1508040742
Name:LATERZA, GINA M (PCC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:LATERZA
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S MAIN ST STE 2511-22
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1072
Mailing Address - Country:US
Mailing Address - Phone:330-687-4439
Mailing Address - Fax:330-319-6592
Practice Address - Street 1:520 S MAIN ST STE 2511-22
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1072
Practice Address - Country:US
Practice Address - Phone:330-687-4439
Practice Address - Fax:330-319-6592
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0007871101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1508040742Medicare UPIN