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General NPI Number Information
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NPI Number | 1699355966
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Entity Type | Individual
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Provider Name | CONNIETORETTA AL-SHAMI OCPRS
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Gender | Female
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Dates
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Enumeration Date | 04/12/2021
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 25201 CHAGRIN BLVD
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City | BEACHWOOD
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State | OH
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Zip | 44122-5600
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Country | US
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Telephone | 216-910-9015
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Fax | 216-910-9015
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Provider Business Mailing Address
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Address Line | 3214 PROSPECT AVE E
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City | CLEVELAND
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State | OH
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Zip | 44115-2614
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Country | US
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Telephone | 216-910-9015
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 0002339
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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