Healthcare Provider Details

I. General information

NPI: 1174012462
Provider Name (Legal Business Name): CARLY SEKERAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 04/27/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 STATION ST STE 112
MENTOR OH
44060-4962
US

IV. Provider business mailing address

8500 STATION ST STE 112
MENTOR OH
44060-4962
US

V. Phone/Fax

Practice location:
  • Phone: 404-299-8159
  • Fax:
Mailing address:
  • Phone: 404-299-8159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: