Provider Demographics
NPI:1528205655
Name:PATAK-PIETRAFESA, MICHELE (MSW, LISW-S)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:PATAK-PIETRAFESA
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E KANAWHA AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1212
Mailing Address - Country:US
Mailing Address - Phone:614-450-2155
Mailing Address - Fax:614-675-2216
Practice Address - Street 1:3840 N HIGH ST STE D
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3761
Practice Address - Country:US
Practice Address - Phone:614-450-2155
Practice Address - Fax:614-675-2216
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1303088104100000X
OHS.0701361-TRNE390200000X
OHI.1303088.SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicaid
OH0170531Medicaid