Provider Demographics
NPI:1750335295
Name:DIMOND, ANNETTE L (LISW)
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:L
Last Name:DIMOND
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 1:20033 DETROIT RD
Mailing Address - Street 2:#201
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-2400
Mailing Address - Country:US
Mailing Address - Phone:216-523-8850
Mailing Address - Fax:440-356-6695
Practice Address - Street 1:20033 DETROIT RD
Practice Address - Street 2:#201
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-2400
Practice Address - Country:US
Practice Address - Phone:216-523-8850
Practice Address - Fax:440-356-6695
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-73691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDISW18032Medicare ID - Type Unspecified
OHP43209Medicare UPIN