Provider Demographics
NPI:1326452814
Name:JOHNSON-LEE, SYLVIA (LISW-S)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:JOHNSON-LEE
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 E 89TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-2007
Mailing Address - Country:US
Mailing Address - Phone:216-231-3772
Mailing Address - Fax:216-231-5040
Practice Address - Street 1:1905 E 89TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-2007
Practice Address - Country:US
Practice Address - Phone:216-231-3772
Practice Address - Fax:216-231-5040
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH991589101YA0400X
OHI. 12007201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)