Provider Demographics
NPI:1619011145
Name:DIDATO, VICTORIA KEPLER (MA, LPC, LSW, DAPA)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:KEPLER
Last Name:DIDATO
Suffix:
Gender:F
Credentials:MA, LPC, LSW, DAPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-0453
Mailing Address - Country:US
Mailing Address - Phone:330-263-0579
Mailing Address - Fax:330-263-0579
Practice Address - Street 1:132 S MARKET ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-4765
Practice Address - Country:US
Practice Address - Phone:330-263-0579
Practice Address - Fax:330-263-0579
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC3144101YM0800X
OHS7329104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1343304OtherAETNA INSURANCE