Provider Demographics
NPI:1083475255
Name:SMITH, MAKANYA LATASHA SARVERA
Entity Type:Individual
Prefix:
First Name:MAKANYA
Middle Name:LATASHA SARVERA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIKKI
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3441 W 52ND ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-5817
Mailing Address - Country:US
Mailing Address - Phone:216-799-9944
Mailing Address - Fax:
Practice Address - Street 1:3441 W 52ND ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-5817
Practice Address - Country:US
Practice Address - Phone:216-799-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH178538101YA0400X
OHFPS.000101175T00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty