Provider Demographics
NPI:1710323522
Name:GREG FRANKENFIELD, LISW, LLC
Entity Type:Organization
Organization Name:GREG FRANKENFIELD, LISW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIRAE
Authorized Official - Middle Name:COLETTE
Authorized Official - Last Name:FRANKENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-522-8109
Mailing Address - Street 1:788 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1921
Mailing Address - Country:US
Mailing Address - Phone:419-756-2828
Mailing Address - Fax:419-756-9913
Practice Address - Street 1:788 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1921
Practice Address - Country:US
Practice Address - Phone:419-756-2828
Practice Address - Fax:419-756-9913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 00071271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2975722Medicaid
OHSW 32561Medicare UPIN