Provider Demographics
NPI:1568918118
Name:MOTYLEWSKI, ANN (LISW-S)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:MOTYLEWSKI
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 AQUA MARINE BLVD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2587
Mailing Address - Country:US
Mailing Address - Phone:440-829-1691
Mailing Address - Fax:
Practice Address - Street 1:2075 SOUTH AVON BELDON BLVD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:OH
Practice Address - Zip Code:44044
Practice Address - Country:US
Practice Address - Phone:440-748-1049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 53961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical