Healthcare Provider Details

I. General information

NPI: 1043727977
Provider Name (Legal Business Name): RENEE D GILROY LSW, LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2017
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5209 DETROIT AVE
CLEVELAND OH
44102-2224
US

IV. Provider business mailing address

4400 EUCLID AVE
CLEVELAND OH
44103-3734
US

V. Phone/Fax

Practice location:
  • Phone: 216-325-9612
  • Fax:
Mailing address:
  • Phone: 216-325-9612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.161985
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1903442
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: