Healthcare Provider Details

I. General information

NPI: 1639818198
Provider Name (Legal Business Name): PAUL SGONDEA- FORSYTH LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26220 CENTER RIDGE RD
WESTLAKE OH
44145-4016
US

IV. Provider business mailing address

26220 CENTER RIDGE RD
WESTLAKE OH
44145-4016
US

V. Phone/Fax

Practice location:
  • Phone: 440-782-1872
  • Fax:
Mailing address:
  • Phone: 440-782-1872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2608417
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: