Provider Demographics
NPI:1477072510
Name:MCNEELY, THERESE M (LSW)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:M
Last Name:MCNEELY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32907 FOX CHAPPEL LN
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2337
Mailing Address - Country:US
Mailing Address - Phone:216-392-4418
Mailing Address - Fax:
Practice Address - Street 1:26032 DETROIT RD STE 1
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2478
Practice Address - Country:US
Practice Address - Phone:440-250-9414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-10
Last Update Date:2017-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.17013271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical