Healthcare Provider Details

I. General information

NPI: 1366355596
Provider Name (Legal Business Name): PRISCA MAPENDO KASAMBAYI LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3569 RIDGE RD
CLEVELAND OH
44102-5443
US

IV. Provider business mailing address

PO BOX 72674
CLEVELAND OH
44192-0002
US

V. Phone/Fax

Practice location:
  • Phone: 216-281-0872
  • Fax: 216-961-5429
Mailing address:
  • Phone: 216-281-0872
  • Fax: 216-961-5429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2614523
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: