Provider Demographics
NPI:1093829616
Name:SACK, KRISTI L (LISW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:L
Last Name:SACK
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10000 BRECKSVILLE RD
Mailing Address - Street 2:116A (B) LOUIS STOKES CLEVELAND VA MEDICAL CENTER
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-3204
Mailing Address - Country:US
Mailing Address - Phone:440-526-3030
Mailing Address - Fax:440-740-2382
Practice Address - Street 1:10000 BRECKSVILLE RD
Practice Address - Street 2:116A (B) LOUIS STOKES CLEVELAND VA MEDICAL CENTER
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-3204
Practice Address - Country:US
Practice Address - Phone:440-526-3030
Practice Address - Fax:440-740-2382
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHI102471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical