Healthcare Provider Details

I. General information

NPI: 1902569650
Provider Name (Legal Business Name): NELLY RENEE EFFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 CARNEGIE AVE
CLEVELAND OH
44115-2629
US

IV. Provider business mailing address

2828 CARNEGIE AVE
CLEVELAND OH
44115-2629
US

V. Phone/Fax

Practice location:
  • Phone: 216-859-9500
  • Fax:
Mailing address:
  • Phone: 216-859-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.196105
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.178651
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: