Healthcare Provider Details

I. General information

NPI: 1659626331
Provider Name (Legal Business Name): ILANA T PASTERNAK LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 WOODLAND AVE STE 703
CLEVELAND OH
44104-2775
US

IV. Provider business mailing address

3601 HIGHVIEW AVE
CLEVELAND OH
44109-2734
US

V. Phone/Fax

Practice location:
  • Phone: 216-431-2018
  • Fax:
Mailing address:
  • Phone: 216-906-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.163045
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: