Provider Demographics
NPI:1114256443
Name:GOLBA, DAWN L (LISW-S)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:L
Last Name:GOLBA
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2641
Mailing Address - Country:US
Mailing Address - Phone:440-260-6117
Mailing Address - Fax:216-529-1630
Practice Address - Street 1:15200 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4019
Practice Address - Country:US
Practice Address - Phone:440-260-6117
Practice Address - Fax:216-529-1630
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI75641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical