Basic Information
| Provider Information | |||||||||
| NPI: | 1710044946 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARCEL DE HERMANAS | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LSW, LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 643 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457500643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403745853 | ||||||||
| FaxNumber: | 7403746332 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 UNION SQ STE 1 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457503033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403733001 | ||||||||
| FaxNumber: | 7403733042 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 12/31/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | E2377 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 1812 | WV | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | S9206 | OH | N | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 11589524 | 01 | OH | CAQH | OTHER | S9206 | 01 | OH | SOCIAL WORK LICENSE | OTHER | E2377 | 01 | OH | CLINICAL COUNSELOR LICENS | OTHER | 138617 | 01 | OH | VALUEOPTIONS PROVIDER | OTHER |