Provider Demographics
NPI:1083398036
Name:KUZMISHIN MAST, CATHERINE (MED, LPCC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:KUZMISHIN MAST
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 S MILLER RD APT 3
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4125
Mailing Address - Country:US
Mailing Address - Phone:330-618-2401
Mailing Address - Fax:
Practice Address - Street 1:6802 W SNOWVILLE RD STE B
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-3296
Practice Address - Country:US
Practice Address - Phone:216-468-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103714101YM0800X
OHE.2303832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health