Provider Demographics
NPI:1235220070
Name:KEITH, ROCHELLE (LSW)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 W CREEK RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2139
Mailing Address - Country:US
Mailing Address - Phone:216-986-1170
Mailing Address - Fax:216-986-1016
Practice Address - Street 1:26250 EUCLID AVE
Practice Address - Street 2:SUITE 414
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3305
Practice Address - Country:US
Practice Address - Phone:216-986-1170
Practice Address - Fax:216-986-1016
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-24046104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker