Provider Demographics
NPI:1861493785
Name:FRIDENSTINE, LOIS ANN (LISW)
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:ANN
Last Name:FRIDENSTINE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47055 W HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44074-9431
Mailing Address - Country:US
Mailing Address - Phone:440-775-2164
Mailing Address - Fax:440-774-2339
Practice Address - Street 1:5 S MAIN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1677
Practice Address - Country:US
Practice Address - Phone:440-775-7171
Practice Address - Fax:440-774-2339
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00051611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical