Facts
- Status
- A
- Credential
- LCSW/LISW
- Type
- Individual
- Enumeration date
- 2013-11-12
- Last updated
- 2024-11-12
Licenses
- License NV
- 7890-C
- License OH
- I.2405945
Location
- Practice location
- 20611 EUCLID AVE
- City
- EUCLID OH
- Postal code
- 441171521
- Phone
- 216-859-2710
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.