Provider Demographics
NPI:1306397567
Name:GEMERCHAK, ED III
Entity Type:Individual
Prefix:
First Name:ED
Middle Name:
Last Name:GEMERCHAK
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3686 NORMANDY RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-5254
Mailing Address - Country:US
Mailing Address - Phone:216-217-1637
Mailing Address - Fax:
Practice Address - Street 1:6001 WOODLAND AVE STE 703
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-2775
Practice Address - Country:US
Practice Address - Phone:216-431-2018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0800146-SUPV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker