Provider Demographics
NPI:1124083571
Name:DIPAOLO, JAY A (LISW)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:A
Last Name:DIPAOLO
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 COMMUNITY RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2356
Mailing Address - Country:US
Mailing Address - Phone:330-633-1206
Mailing Address - Fax:330-633-1364
Practice Address - Street 1:85 COMMUNITY RD
Practice Address - Street 2:SUITE F
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2356
Practice Address - Country:US
Practice Address - Phone:330-633-1206
Practice Address - Fax:330-633-1364
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI72551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHD1SW27111Medicare ID - Type UnspecifiedPROVIDER #