Healthcare Provider Details

I. General information

NPI: 1902381478
Provider Name (Legal Business Name): SHARON ROTBLATT LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3789B GREEN RD
BEACHWOOD OH
44122-5705
US

IV. Provider business mailing address

100 RIVERVIEW CT
CHAGRIN FALLS OH
44022-3370
US

V. Phone/Fax

Practice location:
  • Phone: 216-464-5800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA167797
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1903654
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: