Provider Demographics
NPI:1528567898
Name:STANLEY, DOROTHEA JEAN (LISW)
Entity Type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:JEAN
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 STUTZ DR STE D
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9176
Mailing Address - Country:US
Mailing Address - Phone:330-286-3173
Mailing Address - Fax:330-286-3498
Practice Address - Street 1:3620 STUTZ DR STE D
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9176
Practice Address - Country:US
Practice Address - Phone:330-286-3173
Practice Address - Fax:330-286-3498
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.7007441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical