Healthcare Provider Details

I. General information

NPI: 1124327192
Provider Name (Legal Business Name): LAKEISHA SHANEE DORSEY LISW-S, PSY.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17325 EUCLID AVE STE 2003
CLEVELAND OH
44112-1273
US

IV. Provider business mailing address

17325 EUCLID AVE STE 2003
CLEVELAND OH
44112-1273
US

V. Phone/Fax

Practice location:
  • Phone: 216-772-0229
  • Fax:
Mailing address:
  • Phone: 216-772-0229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2102551
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: