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NPI Code Detail

MEDICARE: MR. CHARLES EDWARD VAN LEER

MEDICARE: MR. CHARLES EDWARD VAN LEER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1023685443
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHARLES EDWARD VAN LEER
Provider Business Mailing Address
First Line : 17325 EUCLID AVE STE 2191
Second Line :
City : CLEVELAND
State : OH
Zip : 44112-1275
Country : US
Telephone Number : 216-260-9022
Fax Number :
Provider Business Practice Location Address
First Line : 5 SEVERANCE CIR STE 201
Second Line :
City : CLEVELAND HTS
State : OH
Zip : 44118-1567
Country : US
Telephone Number : 216-659-5406
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2021
Last Update Date : 08/03/2023

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Directions to “ MR. CHARLES EDWARD VAN LEER ” Practice Location

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