Provider Demographics
NPI:1386767184
Name:FIALA, DAVID JOHN (LISW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOHN
Last Name:FIALA
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 1:11545 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:OH
Mailing Address - Zip Code:44021-9201
Mailing Address - Country:US
Mailing Address - Phone:330-562-9009
Mailing Address - Fax:440-708-1918
Practice Address - Street 1:11545 LANCASTER DR
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:OH
Practice Address - Zip Code:44021-9201
Practice Address - Country:US
Practice Address - Phone:330-562-9009
Practice Address - Fax:440-708-1918
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00082561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical