Provider Demographics
NPI:1215076047
Name:NAZOR, DERYL STERLING (LSW)
Entity type:Individual
Prefix:MR
First Name:DERYL
Middle Name:STERLING
Last Name:NAZOR
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 WALNUT BLVD.
Mailing Address - Street 2:P O BOX 802
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44005-0802
Mailing Address - Country:US
Mailing Address - Phone:440-964-9496
Mailing Address - Fax:
Practice Address - Street 1:4200 PARK AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6887
Practice Address - Country:US
Practice Address - Phone:440-992-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS00034091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical