Healthcare Provider Details

I. General information

NPI: 1518219492
Provider Name (Legal Business Name): DEMITRA TURNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 E 22ND ST
CLEVELAND OH
44115-3202
US

IV. Provider business mailing address

73 WILLIAM ST
BEDFORD OH
44146-4631
US

V. Phone/Fax

Practice location:
  • Phone: 216-696-5800
  • Fax: 216-696-6592
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberS0030950
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: