Provider Demographics
NPI:1780814350
Name:MALTESE, NANNETTE (IMFT, LICDC)
Entity type:Individual
Prefix:
First Name:NANNETTE
Middle Name:
Last Name:MALTESE
Suffix:
Gender:F
Credentials:IMFT, LICDC
Other - Prefix:
Other - First Name:NANNETTE
Other - Middle Name:
Other - Last Name:FADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3249 STERLINGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3132
Mailing Address - Country:US
Mailing Address - Phone:702-810-5940
Mailing Address - Fax:
Practice Address - Street 1:122 W FRONT ST STE D
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1467
Practice Address - Country:US
Practice Address - Phone:702-810-5940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01313106H00000X
OHF1500022106H00000X
NV2556225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist