Provider Demographics
NPI:1972971398
Name:MCINTOSH-THOMAS, GLADYS (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:
Last Name:MCINTOSH-THOMAS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:MISS
Other - First Name:GLADYS
Other - Middle Name:
Other - Last Name:MCINTOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1537 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-1023
Mailing Address - Country:US
Mailing Address - Phone:330-545-5214
Mailing Address - Fax:330-545-5986
Practice Address - Street 1:1537 N STATE ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-1023
Practice Address - Country:US
Practice Address - Phone:330-545-5214
Practice Address - Fax:330-545-5986
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0004685-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical