Provider Demographics
NPI:1396158549
Name:SIDOTI, BABE (LPSC)
Entity type:Individual
Prefix:
First Name:BABE
Middle Name:
Last Name:SIDOTI
Suffix:
Gender:F
Credentials:LPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-3539
Mailing Address - Country:US
Mailing Address - Phone:614-537-7615
Mailing Address - Fax:
Practice Address - Street 1:1536 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3539
Practice Address - Country:US
Practice Address - Phone:614-537-7615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1443543101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH044743Medicaid