Provider Demographics
NPI:1033603147
Name:OTOO, TIA (LSW)
Entity Type:Individual
Prefix:MRS
First Name:TIA
Middle Name:
Last Name:OTOO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:
Other - Last Name:HICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:3100 EUCLID AVE.
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2508
Mailing Address - Country:US
Mailing Address - Phone:440-234-2006
Mailing Address - Fax:
Practice Address - Street 1:3100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2508
Practice Address - Country:US
Practice Address - Phone:216-361-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1600826104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker