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General NPI Number Information
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NPI Number | 1306245196
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Entity Type | Individual
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Provider Name | ASHAY MONAE BUCKNER LISW
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Gender | Female
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 07/03/2019
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Provider Practice Location Address
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Address Line | 1536 SAINT CLAIR AVE NE # S19
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City | CLEVELAND
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State | OH
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Zip | 44114
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Country | US
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Telephone | 216-220-7250
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Fax |
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Provider Business Mailing Address
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Address Line | 1536 SAINT CLAIR AVE NE # S19
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City | CLEVELAND
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State | OH
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Zip | 44114-2004
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Country | US
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Telephone | 216-990-4569
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S1450710
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License Number State | OH
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