Provider Demographics
NPI:1104284504
Name:BARTSCH, LAURA MATTIELLO (LISW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MATTIELLO
Last Name:BARTSCH
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 1:640 OLDE MILL DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-6386
Mailing Address - Country:US
Mailing Address - Phone:614-668-8583
Mailing Address - Fax:
Practice Address - Street 1:640 OLDE MILL DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-6386
Practice Address - Country:US
Practice Address - Phone:614-668-8583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0700192-SUPV104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker