Provider Demographics
NPI:1710223490
Name:DVORIN-FREMONT, VANESSA (MA, MSSA, LISW-S)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DVORIN-FREMONT
Suffix:
Gender:F
Credentials:MA, MSSA, LISW-S
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:FREMONT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MSSA, LISW-S
Mailing Address - Street 1:4502 GROVELAND RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3923
Mailing Address - Country:US
Mailing Address - Phone:216-440-4521
Mailing Address - Fax:216-297-9522
Practice Address - Street 1:4502 GROVELAND RD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3923
Practice Address - Country:US
Practice Address - Phone:216-440-4521
Practice Address - Fax:216-297-9522
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1100138-S104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker