Provider Demographics
NPI:1083133896
Name:PUDA, CHELSEA DAWN (CDCA)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:DAWN
Last Name:PUDA
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30800 CHAGRIN BLVD.
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:216-591-0324
Mailing Address - Fax:216-591-1243
Practice Address - Street 1:1302 WINSLOW AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-2336
Practice Address - Country:US
Practice Address - Phone:216-781-0550
Practice Address - Fax:216-771-1563
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.164576101YA0400X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2374229Medicaid