Provider Demographics
NPI:1700033560
Name:THOMAS, BECKY (LISW-S)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:THOMAS
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 1:1321 APACHE PASS
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5333
Mailing Address - Country:US
Mailing Address - Phone:216-570-1104
Mailing Address - Fax:330-626-9286
Practice Address - Street 1:1321 APACHE PASS
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5333
Practice Address - Country:US
Practice Address - Phone:216-570-1104
Practice Address - Fax:330-626-9286
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-24
Last Update Date:2008-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI08000891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI0800089OtherSOCIAL WORK