Healthcare Provider Details

I. General information

NPI: 1184114571
Provider Name (Legal Business Name): BERRAC J STRODE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 MONARCH ST STE 100
LEXINGTON KY
40513-1820
US

IV. Provider business mailing address

1030 MONARCH ST STE 100
LEXINGTON KY
40513-1820
US

V. Phone/Fax

Practice location:
  • Phone: 216-468-5000
  • Fax: 216-456-8128
Mailing address:
  • Phone: 216-468-5000
  • Fax: 216-456-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW00001485
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: