Basic Information
| Provider Information | |||||||||
| NPI: | 1316481948 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIGLIORE | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MSW, LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 841 STEUBENVILLE AVE | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437252301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8556927247 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2500 JOHN GLENN HWY | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404394428 | ||||||||
| FaxNumber: | 7404393389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2016 | ||||||||
| LastUpdateDate: | 12/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.1000269 | OH | N | Behavioral Health & Social Service Providers | Social Worker | 101YA0400X | LCDCIII.162279 | OH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | I.2002530 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 0263970 | 05 | OH | MEDICAID | 1316481948 | 05 | OH | MEDICAID |