Healthcare Provider Details

I. General information

NPI: 1730800541
Provider Name (Legal Business Name): LEEAN YAMILET ANDINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 EUCLID AVE
CLEVELAND OH
44103-3736
US

IV. Provider business mailing address

6220 CAROL DR
BROOKPARK OH
44142-3827
US

V. Phone/Fax

Practice location:
  • Phone: 216-432-7200
  • Fax:
Mailing address:
  • Phone: 216-682-9751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2406087
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number181942
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: