Provider Demographics
NPI:1376045542
Name:WHITEAMIRE, MARY (SW-T)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WHITEAMIRE
Suffix:
Gender:F
Credentials:SW-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11807 FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5107
Mailing Address - Country:US
Mailing Address - Phone:216-283-4400
Mailing Address - Fax:216-283-5359
Practice Address - Street 1:13422 KINSMAN RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-4410
Practice Address - Country:US
Practice Address - Phone:216-283-4400
Practice Address - Fax:216-283-5359
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1610231104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker