| Lara Waldenmaier, | |
|
221 E 320th St, Willowick, OH 44095-3539 | |
| (440) 742-4656 | |
| (440) 792-5081 |
| Full Name | Lara Waldenmaier |
|---|---|
| Gender | Female |
| Speciality | Counselor |
| Location | 221 E 320th St, Willowick, Ohio |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396108445 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | E.0008228 (Ohio) | Primary |
| Entity Name | Sondermind Provider Network Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1760854442 PECOS PAC ID: 9537572490 Enrollment ID: O20210316002509 |
| Mailing Address | Practice Location Address |
|---|---|
| Lara Waldenmaier, 221 E 320th St, Willowick, OH 44095-3539 Ph: (440) 742-4656 | Lara Waldenmaier, 221 E 320th St, Willowick, OH 44095-3539 Ph: (440) 742-4656 |
Yiannoula Mavroidis, LPCC-S, BC-TMH Counselor Medicare: Not Enrolled in Medicare Practice Location: 34679 Vine St, Willowick, OH 44095 Phone: 216-284-0463 | |
Latasha Johnson, Counselor Medicare: Not Enrolled in Medicare Practice Location: 31501 N Marginal Dr Apt C, Willowick, OH 44095 Phone: 216-203-1898 | |
Craig W Stephens Ii, Counselor Medicare: Not Enrolled in Medicare Practice Location: 32014 N Marginal Dr Apt 384, Willowick, OH 44095 Phone: 216-336-3312 | |
Haley Rose Tizzano, Counselor Medicare: Not Enrolled in Medicare Practice Location: 32412 Lake Shore Blvd, Willowick, OH 44095 Phone: 440-478-1609 | |
Kylie Mccarthy, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 34679 Vine St, Willowick, OH 44095 Phone: 216-284-0463 | |
Marsha Ann Coleman, LISW-S Counselor Medicare: Not Enrolled in Medicare Practice Location: 30333 Lake Shore Blvd, Willowick, OH 44095 Phone: 419-571-3318 |