Provider Demographics
NPI:1275060063
Name:ANDRES, RHONDA
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:ANDRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W LAKESIDE AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-1069
Mailing Address - Country:US
Mailing Address - Phone:216-698-6464
Mailing Address - Fax:216-443-8272
Practice Address - Street 1:310 W LAKESIDE AVE STE 500
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-1069
Practice Address - Country:US
Practice Address - Phone:216-698-6464
Practice Address - Fax:216-443-8272
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0023515104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker