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NPI Code Detail

MEDICARE: MRS. CAROLYN DIANE PITTS-CLAY BSW, CDCA, OCPSA

MEDICARE: MRS. CAROLYN DIANE PITTS-CLAY BSW, CDCA, OCPSA
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
1390200000XStudent in an Organized Health Care Education/Training ProgramBSWOH
2405300000XPrevention ProfessionalOCPSA.161399OH
3101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.100054OH

General Provider Information

NPI Number : 1801392022
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CAROLYN DIANE PITTS-CLAY BSW, CDCA, OCPSA
Provider Business Mailing Address
First Line : 4100 FRANKLIN BLVD
Second Line :
City : CLEVELAND
State : OH
Zip : 44113-2842
Country : US
Telephone Number : 216-658-4640
Fax Number : 216-281-2506
Provider Business Practice Location Address
First Line : 4100 FRANKLIN BLVD
Second Line :
City : CLEVELAND
State : OH
Zip : 44113-2842
Country : US
Telephone Number : 216-281-2500
Fax Number : 216-281-2506
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2018
Last Update Date : 04/05/2018

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Directions to “ MRS. CAROLYN DIANE PITTS-CLAY BSW, CDCA, OCPSA” Practice Location

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