Provider Demographics
NPI:1235326992
Name:HALL MENNES, MARY CELESTINE (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CELESTINE
Last Name:HALL MENNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:
Other - Last Name:HALL-MENNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8055 MAYFIELD RD
Mailing Address - Street 2:STE 105
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2447
Mailing Address - Country:US
Mailing Address - Phone:440-214-8027
Mailing Address - Fax:216-201-8173
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-286-6260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0905502084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000538617OtherANTHEM
OH421799OtherWELLCARE MEDICAID
OH2770943Medicaid
OH000000225208OtherUNISON
PA1024582290001Medicaid
OH9731098OtherAETNA
PA1024582290001Medicaid
OH2770943Medicaid