Provider Demographics
NPI:1780128959
Name:BANASZAK, AIRIELLE (LISW-S)
Entity type:Individual
Prefix:
First Name:AIRIELLE
Middle Name:
Last Name:BANASZAK
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21245 LORAIN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2140
Mailing Address - Country:US
Mailing Address - Phone:216-337-3189
Mailing Address - Fax:
Practice Address - Street 1:21245 LORAIN RD STE 201
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2140
Practice Address - Country:US
Practice Address - Phone:216-337-3189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1000019.SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical