Healthcare Provider Details

I. General information

NPI: 1700342177
Provider Name (Legal Business Name): KEITH O SEWARD CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3746 PROSPECT AVE E
CLEVELAND OH
44115-2706
US

IV. Provider business mailing address

3781 NORTHWOOD RD
UNIVERSITY HT OH
44118-3737
US

V. Phone/Fax

Practice location:
  • Phone: 216-391-6672
  • Fax:
Mailing address:
  • Phone: 216-470-7937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.169227
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: