Healthcare Provider Details

I. General information

NPI: 1548578230
Provider Name (Legal Business Name): CENTER FOR THE TREATMENT OF WORK-RELATED INJ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7055 ENGLE RD 401
CLEVELAND OH
44130-8491
US

IV. Provider business mailing address

7055 ENGLE RD 401
CLEVELAND OH
44130-8491
US

V. Phone/Fax

Practice location:
  • Phone: 440-243-6370
  • Fax: 440-243-6530
Mailing address:
  • Phone: 440-243-6370
  • Fax: 440-243-6530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0001310
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1041C0700X
License Number StateOH

VIII. Authorized Official

Name: STEPHEN W. CASTOR
Title or Position: PRESIDENT/CEO
Credential: DPM
Phone: 440-243-6370