Provider Demographics
NPI:1629026687
Name:LIBBEY, PAULA G (LISW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:G
Last Name:LIBBEY
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 1:3974 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406
Mailing Address - Country:US
Mailing Address - Phone:330-533-6767
Mailing Address - Fax:330-533-1665
Practice Address - Street 1:3974 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406
Practice Address - Country:US
Practice Address - Phone:330-533-6767
Practice Address - Fax:330-533-1665
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI8043101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2053647Medicaid
OH2053647Medicaid