Provider Demographics
NPI:1679601165
Name:MORENO ZERBY, DIANE MARIE (LISW-S)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:MORENO ZERBY
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:PO BOX 8675
Mailing Address - Street 2:2650 CLEVELAND AVE NW
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44711-8675
Mailing Address - Country:US
Mailing Address - Phone:330-933-4903
Mailing Address - Fax:
Practice Address - Street 1:1445 HARRISON AVE NW STE 301
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708
Practice Address - Country:US
Practice Address - Phone:330-933-4903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-0005427101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health