MEDICARE: RONDA BLANEY LICDC

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	954292	OH

General Provider Information

NPI Number	:	1174975478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONDA BLANEY LICDC

Provider Business Mailing Address
First Line	:	770 KENBRIDGE DR
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-1931
Country	:	US
Telephone Number	:	216-235-7778
Fax Number	:

Provider Business Practice Location Address
First Line	:	1276 W 3RD ST STE 210
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-1512
Country	:	US
Telephone Number	:	216-443-8253
Fax Number	:	216-443-8272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	07/11/2016

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Directions to “ RONDA BLANEY LICDC” Practice Location

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