Provider Demographics
NPI:1710283692
Name:BERDINE, ASHLEY L (LSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:BERDINE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 GRAHAM RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1051
Mailing Address - Country:US
Mailing Address - Phone:330-928-0044
Mailing Address - Fax:330-928-0303
Practice Address - Street 1:650 GRAHAM RD STE 101
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221
Practice Address - Country:US
Practice Address - Phone:330-928-0044
Practice Address - Fax:330-928-0303
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.18008871041C0700X
OHS.10004401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0279573Medicaid