Provider Demographics
NPI:1316968050
Name:FUCHSMAN, EDITH MARYA (LISW)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:MARYA
Last Name:FUCHSMAN
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 1:44923 E HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44074-9611
Mailing Address - Country:US
Mailing Address - Phone:440-774-3528
Mailing Address - Fax:440-774-2339
Practice Address - Street 1:5 S MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1600
Practice Address - Country:US
Practice Address - Phone:440-775-7171
Practice Address - Fax:440-774-2339
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00054781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000232354Medicare UPIN
OH7994485Medicare UPIN
OHFUSW25181Medicare ID - Type UnspecifiedMEDICARE PALMETTO GBA
OHP3456907Medicare UPIN
OH384695Medicare UPIN