Provider Demographics
NPI:1922545706
Name:MAFFEI, VINCENT (LSW, MSW)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:MAFFEI
Suffix:
Gender:M
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 S BROAD ST
Mailing Address - Street 2:SUITE 204A
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1442
Mailing Address - Country:US
Mailing Address - Phone:330-531-8604
Mailing Address - Fax:330-758-5121
Practice Address - Street 1:132 S BROAD ST
Practice Address - Street 2:SUITE 204A
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1442
Practice Address - Country:US
Practice Address - Phone:330-531-8604
Practice Address - Fax:330-758-5121
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0029335104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker