Provider Demographics
NPI:1871327627
Name:CLEVENGER, NICOLE MARIE (BFA, MSSA)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MARIE
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:BFA, MSSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34801 IRIS LN
Mailing Address - Street 2:
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095-2465
Mailing Address - Country:US
Mailing Address - Phone:440-346-8442
Mailing Address - Fax:
Practice Address - Street 1:11101 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1813
Practice Address - Country:US
Practice Address - Phone:216-721-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker