Healthcare Provider Details

I. General information

NPI: 1598327751
Provider Name (Legal Business Name): YVETTE GOLDURS, LISW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20575 CENTER RIDGE RD STE 119
ROCKY RIVER OH
44116-3422
US

IV. Provider business mailing address

3867 GLENWOOD RD
CLEVELAND HEIGHTS OH
44121-1649
US

V. Phone/Fax

Practice location:
  • Phone: 216-526-4208
  • Fax: 216-274-6388
Mailing address:
  • Phone: 216-526-4208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: YVETTE GOLDURS
Title or Position: OWNER
Credential: LISW-S
Phone: 216-526-4208