Individual
IDA L TERRENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
13422 KINSMAN RD, CLEVELAND, OH 44120-4410
(216) 283-4400
(216) 283-5359
Mailing address
14925 CARDINAL AVE, CLEVELAND, OH 44110-2318
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
S.0029259
OH
Other
Enumeration date
03/26/2018
Last updated
03/26/2018
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