Provider Demographics
NPI:1508414186
Name:MENCKE, CHRISTOPHER LLOYDE (LSW, CDCA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LLOYDE
Last Name:MENCKE
Suffix:
Gender:M
Credentials:LSW, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8411 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-3932
Mailing Address - Country:US
Mailing Address - Phone:216-441-0200
Mailing Address - Fax:216-441-3637
Practice Address - Street 1:205 WADSWORTH RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9580
Practice Address - Country:US
Practice Address - Phone:234-217-8882
Practice Address - Fax:234-217-8941
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1903396104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker