Provider Demographics
NPI:1679936983
Name:BEITZEL, NECOLE M (MSW, LISW)
Entity type:Individual
Prefix:
First Name:NECOLE
Middle Name:M
Last Name:BEITZEL
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PERSHING AVE SE
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-3159
Mailing Address - Country:US
Mailing Address - Phone:330-437-9638
Mailing Address - Fax:
Practice Address - Street 1:1307 S MAIN ST APT 5B
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-4253
Practice Address - Country:US
Practice Address - Phone:330-437-9638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.17006791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical