Provider Demographics
NPI:1407305758
Name:SLAUGHTER, MARIA (LSW,MSSA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:LSW,MSSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12701 SHAKER BLVD
Mailing Address - Street 2:308A
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-2094
Mailing Address - Country:US
Mailing Address - Phone:216-501-3396
Mailing Address - Fax:216-501-3396
Practice Address - Street 1:3950 CHESTER AVE
Practice Address - Street 2:107
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-4625
Practice Address - Country:US
Practice Address - Phone:216-431-4131
Practice Address - Fax:216-431-4151
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1502388104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker