Provider Demographics
NPI:1992361059
Name:FERTIG, EMILY (QMHS)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:FERTIG
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 N CANTON RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-3838
Mailing Address - Country:US
Mailing Address - Phone:330-794-4254
Mailing Address - Fax:330-794-4262
Practice Address - Street 1:18 N FORGE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1317
Practice Address - Country:US
Practice Address - Phone:330-762-0591
Practice Address - Fax:330-762-2242
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2121964-TRNE101YM0800X
104100000X, 171M00000X
OHS.22080828104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator