Provider Demographics
NPI:1982198156
Name:HUEGEL, DINA C (QMHS, MSW, LSW)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:C
Last Name:HUEGEL
Suffix:
Gender:F
Credentials:QMHS, MSW, LSW
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:C
Other - Last Name:IACOBUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17626 LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE MILTON
Mailing Address - State:OH
Mailing Address - Zip Code:44429-9762
Mailing Address - Country:US
Mailing Address - Phone:330-651-5156
Mailing Address - Fax:
Practice Address - Street 1:17626 LAKEWOOD AVE
Practice Address - Street 2:
Practice Address - City:LAKE MILTON
Practice Address - State:OH
Practice Address - Zip Code:44429-9762
Practice Address - Country:US
Practice Address - Phone:330-651-5156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA$$$$$$$$$Medicaid