Provider Demographics
NPI:1275078438
Name:BLEISTEIN, KEVIN (LISW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:BLEISTEIN
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 1:3343 BRADFORD RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4229
Mailing Address - Country:US
Mailing Address - Phone:570-428-2785
Mailing Address - Fax:
Practice Address - Street 1:3109 MAYFIELD RD STE 204
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1726
Practice Address - Country:US
Practice Address - Phone:216-245-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1600333-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical