Tina M Lake, LSW is a
Social Worker based in Massillon, Ohio. Tina M Lake is licensed to practice in Ohio (license number S1302473) and her current practice location is
1660 Nave Rd Se, Massillon, Ohio. She can be reached at her office (for appointments etc.) via phone at
(330) 837-9411.
NPI number for Tina M Lake is 1164901054 and her current mailing address is 625 Cleveland Ave Nw, Canton, Ohio. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1164901054.
Healthcare Provider's Profile
| Full Name | Tina M Lake |
|---|
| Gender | Female |
|---|
| Speciality | Social Worker |
|---|
| Location | 1660 Nave Rd Se, Massillon, Ohio |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1164901054
- Provider Enumeration Date: 08/10/2018
- Last Update Date: 08/10/2018
Medical Identifiers
Medical identifiers for Tina M Lake such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1164901054 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | CDCA167304 (Ohio) | Secondary |
| 104100000X | Social Worker | S1302473 (Ohio) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Tina M Lake is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Tina M Lake, LSW
625 Cleveland Ave Nw,
Canton, OH 44702-1805
Ph: (330) 455-0374 | Tina M Lake, LSW
1660 Nave Rd Se,
Massillon, OH 44646-9604
Ph: (330) 837-9411 |
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