Provider Demographics
NPI:1225140890
Name:PERSSE, ROBERT E (LISW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:PERSSE
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 HYDE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2132
Mailing Address - Country:US
Mailing Address - Phone:216-932-5745
Mailing Address - Fax:
Practice Address - Street 1:29133 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5256
Practice Address - Country:US
Practice Address - Phone:440-835-6212
Practice Address - Fax:440-835-6231
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00020311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0308483Medicaid
OHPESW09282Medicare ID - Type UnspecifiedMEDICARE NUMBER
OHPESW09283Medicare ID - Type UnspecifiedMEDICARE NUMBER
OH0308483Medicaid