Provider Demographics
NPI:1497736912
Name:HAYS, CHARLOTTE A (PHO LSW)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:A
Last Name:HAYS
Suffix:
Gender:F
Credentials:PHO LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4979 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2601
Mailing Address - Country:US
Mailing Address - Phone:216-839-2273
Mailing Address - Fax:216-869-0735
Practice Address - Street 1:8748 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1985
Practice Address - Country:US
Practice Address - Phone:216-839-2273
Practice Address - Fax:216-896-0735
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6074103T00000X
OH53853104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2526725Medicaid
OHCP30611Medicare PIN