Provider Demographics
NPI:1093281099
Name:CERNOSKY, LAURA ANNE I (LISW-S, CDCA)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:ANNE
Last Name:CERNOSKY
Suffix:I
Gender:F
Credentials:LISW-S, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W LAKESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-1044
Mailing Address - Country:US
Mailing Address - Phone:216-348-3842
Mailing Address - Fax:
Practice Address - Street 1:7519 MENTOR AVE STE 114
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5410
Practice Address - Country:US
Practice Address - Phone:440-701-6170
Practice Address - Fax:440-527-8043
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1440191104100000X
OHI.20020061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker