Provider Demographics
NPI:1700983533
Name:GAMBITTA, MARYANN (LISW)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:GAMBITTA
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 CALVIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131
Mailing Address - Country:US
Mailing Address - Phone:216-577-7822
Mailing Address - Fax:440-777-9288
Practice Address - Street 1:26777 LORAIN RD
Practice Address - Street 2:SUITE 716
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3200
Practice Address - Country:US
Practice Address - Phone:440-777-9200
Practice Address - Fax:440-777-9288
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00072641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
341862190Medicare UPIN