Provider Demographics
NPI:1679368583
Name:SMALLS, DARREL ROBERT
Entity type:Individual
Prefix:
First Name:DARREL
Middle Name:ROBERT
Last Name:SMALLS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 PARK SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-4153
Mailing Address - Country:US
Mailing Address - Phone:440-384-8601
Mailing Address - Fax:
Practice Address - Street 1:300 PINE HOLLOW BLVD APT 110B
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-3005
Practice Address - Country:US
Practice Address - Phone:440-371-1893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator