Provider Demographics
NPI:1558491191
Name:SHAMBACH, RITA ANN (LISW)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:ANN
Last Name:SHAMBACH
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 1:14701 DETROIT AVE
Mailing Address - Street 2:RM 775
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4120
Mailing Address - Country:US
Mailing Address - Phone:216-228-0010
Mailing Address - Fax:216-228-1610
Practice Address - Street 1:14701 DETROIT AVE
Practice Address - Street 2:RM 775
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4120
Practice Address - Country:US
Practice Address - Phone:216-228-0010
Practice Address - Fax:216-228-1610
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI6011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSHSW17436Medicare ID - Type Unspecified
OHSHSW17435Medicare ID - Type Unspecified