Healthcare Provider Details

I. General information

NPI: 1841983285
Provider Name (Legal Business Name): LESLIE SMITH C-CHW, QMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18120 PURITAS AVE
CLEVELAND OH
44135-3832
US

IV. Provider business mailing address

3206 E 137TH ST
CLEVELAND OH
44120-3237
US

V. Phone/Fax

Practice location:
  • Phone: 216-551-9955
  • Fax:
Mailing address:
  • Phone: 216-551-9955
  • Fax: 216-304-7903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCHW.002118
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: