Provider Demographics
NPI:1255009395
Name:LINDSEY, KENOCTAYA MONEEK (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:KENOCTAYA
Middle Name:MONEEK
Last Name:LINDSEY
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3965 WARRENDALE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2321
Mailing Address - Country:US
Mailing Address - Phone:216-288-9258
Mailing Address - Fax:
Practice Address - Street 1:3965 WARRENDALE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44118-2321
Practice Address - Country:US
Practice Address - Phone:216-288-9258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1901737-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical