Healthcare Provider Details

I. General information

NPI: 1396237798
Provider Name (Legal Business Name): MARY SASILEO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY VOLK

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4269 PEARL RD
CLEVELAND OH
44109
US

IV. Provider business mailing address

4269 PEARL RD
CLEVELAND OH
44109-4234
US

V. Phone/Fax

Practice location:
  • Phone: 216-431-4131
  • Fax: 216-431-4151
Mailing address:
  • Phone: 216-431-4131
  • Fax: 216-431-4151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: