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General NPI Number Information
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NPI Number | 1447342696
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Entity Type | Organization
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Legal Business Name | HISPANIC URBAN MINORITY ALCHOLISM AND DRUG ABUSE OUTREACH PROGRAM
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 3305 W 25TH ST
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City | CLEVELAND
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State | OH
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Zip | 44109-1613
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Country | US
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Telephone | 216-459-1222
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Fax | 216-459-2696
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Provider Business Mailing Address
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Address Line | 3305 W 25TH ST
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City | CLEVELAND
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State | OH
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Zip | 44109-1613
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Country | US
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Telephone | 216-459-1222
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Fax | 216-459-2696
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. SIOBHAN MALAVE
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Credential | LISW-S, LICDC
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Telephone | 216-459-1222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 00978
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 13366
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License Number State | OH
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