Provider Demographics
NPI:1730625138
Name:BARTH, EMILIE ROSE (LISW-S)
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:ROSE
Last Name:BARTH
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 STONEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-3128
Mailing Address - Country:US
Mailing Address - Phone:440-547-6762
Mailing Address - Fax:
Practice Address - Street 1:24600 DETROIT RD STE 265
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2542
Practice Address - Country:US
Practice Address - Phone:440-547-6762
Practice Address - Fax:440-653-9576
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1710011-TRNE101YM0800X
OHS.1903742104100000X
OHI.21032291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker