Healthcare Provider Details

I. General information

NPI: 1083398036
Provider Name (Legal Business Name): CATHERINE KUZMISHIN MAST MED, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6802 W SNOWVILLE RD STE B
BRECKSVILLE OH
44141-3296
US

IV. Provider business mailing address

172 S MILLER RD APT 3
FAIRLAWN OH
44333-4125
US

V. Phone/Fax

Practice location:
  • Phone: 216-468-5000
  • Fax:
Mailing address:
  • Phone: 330-618-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2103714
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2303832
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: