Healthcare Provider Details

I. General information

NPI: 1215468335
Provider Name (Legal Business Name): KIRA L KARABANOVS LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21430 LORAIN RD STE 110
CLEVELAND OH
44126-2148
US

IV. Provider business mailing address

6090 MIDDLEBROOK BLVD
BROOKPARK OH
44142-3220
US

V. Phone/Fax

Practice location:
  • Phone: 216-302-4309
  • Fax:
Mailing address:
  • Phone: 216-470-7025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.1501127-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberI.1501127-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: