Provider Demographics
NPI:1144303041
Name:JARAMILLO, STEPHEN (LSW,LCDC2)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:JARAMILLO
Suffix:
Gender:M
Credentials:LSW,LCDC2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6867 ROSEMONT DR
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-2613
Mailing Address - Country:US
Mailing Address - Phone:440-526-0222
Mailing Address - Fax:
Practice Address - Street 1:3076 REMSEN RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9225
Practice Address - Country:US
Practice Address - Phone:330-722-0750
Practice Address - Fax:330-723-0068
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH965700101YA0400X
OH132724104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker