Provider Demographics
NPI:1861859050
Name:LENARDUZZI, PAUL (LSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LENARDUZZI
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7519 MENTOR AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5410
Mailing Address - Country:US
Mailing Address - Phone:440-701-6170
Mailing Address - Fax:440-527-8043
Practice Address - Street 1:398 W BAGLEY RD STE 13
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1312
Practice Address - Country:US
Practice Address - Phone:440-970-3790
Practice Address - Fax:440-527-8043
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 0020516104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS 0020516OtherSTATE LICENSE
OH0293494Medicaid