MEDICARE: MR. PAUL SGONDEA CDCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	180876	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639818198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL SGONDEA CDCA

Provider Business Mailing Address
First Line	:	20800 CENTER RIDGE RD STE 410
Second Line	:
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116-4306
Country	:	US
Telephone Number	:	440-356-7620
Fax Number	:	440-356-7623

Provider Business Practice Location Address
First Line	:	20800 CENTER RIDGE RD STE 410
Second Line	:
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116-4306
Country	:	US
Telephone Number	:	440-356-7620
Fax Number	:	440-356-7623

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	06/02/2022

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Directions to “ MR. PAUL SGONDEA CDCA” Practice Location

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