Individual provider Active NPI

Scott Michael Lautensleger, LISW-S

  • Clinical Social Worker
  • Canton, OH
National Provider Identifier
1326470493
Registry record updated Mar 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I1600185SUPV Issued in OH
Practice address
733 Market Ave S
Canton, OH 44702-2165
Phone
(330) 489-4600
NPI assigned
Jul 31, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X I1600185SUPV OH Primary

Addresses

Primary practice location

733 Market Ave S
Canton, OH 44702-2165

Mailing address

733 Market Ave S
Canton, OH 44702-2165
Phone (330) 489-4600

Other practice location 1

1680 Nave Rd SE
Massillon, OH 44646-9604
Phone (330) 830-8740

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190410002739 OH Practitioner - Clinical Social Worker 9830430354 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I1600185SUPVOHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Psycho Social Therapies,LTD Clinical CurrentSince May 16, 2019 Accepting new patients
Psycho Social Therapies,LTD CurrentSince May 16, 2019 Accepting new patients

Locations

23715 Mercantile Rd
Ste A203
Beachwood, OH 44122
Phone (216) 292-2880

23366 Commerce Park
Ste 100B
Beachwood, OH 44122
Phone (216) 292-2880

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1375228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553212800000",
    "number": "1326470493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "733 MARKET AVE S",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447022165",
            "telephone_number": "330-489-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "733 MARKET AVE S",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447022165",
            "telephone_number": "330-489-4600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1680 Nave Rd SE",
            "address_purpose": "LOCATION",
            "city": "Massillon",
            "state": "OH",
            "postal_code": "446469604",
            "country_code": "US",
            "telephone_number": "330-830-8740",
            "fax_number": "330-830-0912",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAUTENSLEGER",
        "first_name": "SCOTT",
        "middle_name": "MICHAEL",
        "credential": "LISW-S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-31",
        "last_updated": "2019-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I1600185SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

Verify at the official NPI Registry.