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General NPI Number Information
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NPI Number | 1679289599
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Entity Type | Individual
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Provider Name | CORETTA DANIEL LSW
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Gender | Female
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 1744 PAYNE AVE
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City | CLEVELAND
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State | OH
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Zip | 44114-2910
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Country | US
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Telephone | 216-623-6555
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Fax |
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Provider Business Mailing Address
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Address Line | 3643 CENTRAL AVE
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City | CLEVELAND
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State | OH
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Zip | 44115-3023
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Country | US
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Telephone | 216-659-7080
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | S.1303660
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | S.1303660
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.1303660
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License Number State | OH
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