Provider Demographics
NPI:1972859536
Name:CIOLA, VINCENT MATTHEW (LISW)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:MATTHEW
Last Name:CIOLA
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:BELLE CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43310-9796
Mailing Address - Country:US
Mailing Address - Phone:937-935-0657
Mailing Address - Fax:
Practice Address - Street 1:221 FOUNTAIN PL
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2205
Practice Address - Country:US
Practice Address - Phone:937-593-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.11001761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical