Provider Demographics
NPI:1295212215
Name:FLORES, PRISCILLA A
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:A
Last Name:FLORES
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 1:3355 RICHMOND RD STE 225A
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4180
Mailing Address - Country:US
Mailing Address - Phone:216-831-4149
Mailing Address - Fax:
Practice Address - Street 1:3355 RICHMOND RD STE 225A
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4180
Practice Address - Country:US
Practice Address - Phone:216-831-4149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1802586104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker