| Child And Adolescent Therapy | |
|
30400 Detroit Rd Ste 301 Westlake OH 44145-1855 | |
| (216) 551-7595 | |
| Not Available |
| Full Name | Child And Adolescent Therapy |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 30400 Detroit Rd Ste 301, Westlake, Ohio |
| Authorized Official Name and Position | Candice Rene Sanborn (OWNER) |
| Authorized Official Contact | 2165517595 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Child And Adolescent Therapy 20588 Lorain Rd Apt 14 Fairview Park OH 44126-3466 Ph: (216) 551-7595 | Child And Adolescent Therapy 30400 Detroit Rd Ste 301 Westlake OH 44145-1855 Ph: (216) 551-7595 |
| NPI Number | 1134605983 |
|---|---|
| Provider Enumeration Date | 07/16/2018 |
| Last Update Date | 07/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134605983 | NPI | - | NPPES |
| 0222497 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 1302314-SUPV (Ohio) | Primary |
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