Provider Demographics
NPI:1144989013
Name:LANZA-ROTH, HANNAH
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:LANZA-ROTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 WOLOSYN CIR APT 3
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1371
Mailing Address - Country:US
Mailing Address - Phone:330-540-5550
Mailing Address - Fax:
Practice Address - Street 1:246 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3055
Practice Address - Country:US
Practice Address - Phone:330-298-9391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.179086101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)