Individual
KEATON SOMERVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
22001 FAIRMOUNT BLVD, CLEVELAND, OH 44118-4819
(216) 932-2800
Mailing address
22001 FAIRMOUNT BLVD, CLEVELAND, OH 44118-4819
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S-561-465-636-699
DRIVER'S LICENSE NUMBER
MD
Enumeration date
07/28/2020
Last updated
07/28/2020
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