Provider Demographics
NPI:1669039566
Name:PETO, SHEILA RENEE (LICDC, LSW)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:RENEE
Last Name:PETO
Suffix:
Gender:F
Credentials:LICDC, LSW
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:RENEE
Other - Last Name:PETO-LEVICKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:ROCK CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44084-0263
Mailing Address - Country:US
Mailing Address - Phone:440-563-3400
Mailing Address - Fax:
Practice Address - Street 1:2863 STATE ROUTE 45 N
Practice Address - Street 2:
Practice Address - City:ROCK CREEK
Practice Address - State:OH
Practice Address - Zip Code:44084-9352
Practice Address - Country:US
Practice Address - Phone:440-563-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-26
Last Update Date:2019-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0028368104100000X
OHLICDC.161734101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker