MR. IVAN ROSA LICDC LSW NPI 1215370176

NPI Information

NPI: 1215370176
Provider Name: MR. IVAN ROSA, LICDC, LSW
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
1341 MARKET AVE N
CANTON, OH
ZIP 44714
Phone: (330) 453-8252
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MR. Ivan Rosa, LICDC, LSW is an addiction (substance use disorder) counselor in Canton, OH. MR. Ivan Rosa, LICDC, LSW NPI is 1215370176. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1341 MARKET AVE N
CANTON, OH
ZIP 44714-605
Phone: (330) 453-8252
Fax: (330) 453-6716

The enumeration date for this NPI number is 4/10/2013 and was last updated on 4/10/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	902754CS	OHIO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2901131	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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