| Realize Your Path Llc | |
|
21245 Lorain Rd Ste 201 Fairview Park OH 44126-2140 | |
| (216) 337-3189 | |
| Not Available |
| Full Name | Realize Your Path Llc |
|---|---|
| Speciality | Social Worker |
| Location | 21245 Lorain Rd Ste 201, Fairview Park, Ohio |
| Authorized Official Name and Position | Airielle Siobhan Banaszak (OWNER) |
| Authorized Official Contact | 2163373189 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Realize Your Path Llc 21245 Lorain Rd Ste 201 Fairview Park OH 44126-2140 Ph: (216) 337-3189 | Realize Your Path Llc 21245 Lorain Rd Ste 201 Fairview Park OH 44126-2140 Ph: (216) 337-3189 |
| NPI Number | 1750863288 |
|---|---|
| Provider Enumeration Date | 08/31/2018 |
| Last Update Date | 03/07/2024 |
| Certification Date | 03/07/2024 |
| Medicare PECOS PAC ID | 9335472943 |
|---|---|
| Medicare Enrollment ID | O20190613002927 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750863288 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Airielle Banaszak |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780128959 PECOS PAC ID: 9638451057 Enrollment ID: I20170119002625 |
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