Healthcare Provider Details

I. General information

NPI: 1821602566
Provider Name (Legal Business Name): PATRICK CASEY LENNON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14707 S CHESHIRE ST
BURTON OH
44021-9601
US

IV. Provider business mailing address

13993 SWEETBRIAR LN
NOVELTY OH
44072-9716
US

V. Phone/Fax

Practice location:
  • Phone: 440-887-1100
  • Fax: 440-887-1103
Mailing address:
  • Phone: 440-223-3682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.003500
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: