Provider Demographics
NPI:1386972289
Name:PURGERT, GEORGE BRIAN (LISW-S)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:BRIAN
Last Name:PURGERT
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 PORTAGE TRL
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3035
Mailing Address - Country:US
Mailing Address - Phone:330-928-3904
Mailing Address - Fax:
Practice Address - Street 1:720 PORTAGE TRL
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3035
Practice Address - Country:US
Practice Address - Phone:330-928-3904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 06001401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical