Healthcare Provider Details

I. General information

NPI: 1033429360
Provider Name (Legal Business Name): JAMES P. HLAVATY M.S.W., L.I.S.W.-S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 E. 101ST STREET CLEVELAND SIGHT CENTER
CLEVELAND OH
44106
US

IV. Provider business mailing address

1909 E. 101ST STREET CLEVELAND SIGHT CENTER
CLEVELAND OH
44106
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-8118
  • Fax: 216-791-1101
Mailing address:
  • Phone: 216-791-8118
  • Fax: 216-791-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI-0004372
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: