Provider Demographics
NPI:1669175410
Name:RAMBAUD, LORITA J (QMHS)
Entity type:Individual
Prefix:
First Name:LORITA
Middle Name:J
Last Name:RAMBAUD
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 GREENCREST ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-5003
Mailing Address - Country:US
Mailing Address - Phone:330-526-6565
Mailing Address - Fax:
Practice Address - Street 1:1445 GREENCREST ST NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-5003
Practice Address - Country:US
Practice Address - Phone:330-526-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)