Provider Demographics
NPI:1104178086
Name:BREWER, BERTHA (LISW)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13422 KINSMAN RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-4410
Mailing Address - Country:US
Mailing Address - Phone:216-283-4400
Mailing Address - Fax:
Practice Address - Street 1:13422 KINSMAN RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-4410
Practice Address - Country:US
Practice Address - Phone:216-283-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00001051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical