Provider Demographics
NPI:1235723487
Name:YEFTICH, NICOLE PAULINE
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:PAULINE
Last Name:YEFTICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4757 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-3442
Mailing Address - Country:US
Mailing Address - Phone:216-957-4848
Mailing Address - Fax:216-778-8412
Practice Address - Street 1:4757 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-3442
Practice Address - Country:US
Practice Address - Phone:216-957-4848
Practice Address - Fax:216-778-8412
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2208370104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker