Provider Demographics
NPI:1700248036
Name:FORTUNATO, HELEN SUE
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:SUE
Last Name:FORTUNATO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-2421
Mailing Address - Country:US
Mailing Address - Phone:330-434-4141
Mailing Address - Fax:330-208-2136
Practice Address - Street 1:838 COBURN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1459
Practice Address - Country:US
Practice Address - Phone:330-434-4141
Practice Address - Fax:330-208-2136
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHICDC.954426-CS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)