Basic Information
| Provider Information | |||||||||
| NPI: | 1972181709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BANDIERA | ||||||||
| FirstName: | LORETA | ||||||||
| MiddleName: | RUTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 132 | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457010132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406449872 | ||||||||
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| Practice Location | |||||||||
| Address1: | 195 UNION ST | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430553919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003218293 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2021 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.2101740-TRNE | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.