Provider Demographics
NPI:1508984352
Name:DEUCHER, MARY DIEHL (LISW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:DIEHL
Last Name:DEUCHER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MARGARET
Other - Last Name:DEUCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:14913 GARFIELD RD
Mailing Address - Street 2:SUEITE 302
Mailing Address - City:WAKEMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44889-9584
Mailing Address - Country:US
Mailing Address - Phone:440-965-4775
Mailing Address - Fax:
Practice Address - Street 1:5 S MAIN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1677
Practice Address - Country:US
Practice Address - Phone:440-775-7171
Practice Address - Fax:440-774-2339
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 00094841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical