Provider Demographics
NPI:1518207505
Name:RODRIGUEZ-JOHNSON, RAMONITA (LICDC, LSW)
Entity Type:Individual
Prefix:MISS
First Name:RAMONITA
Middle Name:
Last Name:RODRIGUEZ-JOHNSON
Suffix:
Gender:F
Credentials:LICDC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 W 25TH ST
Mailing Address - Street 2:507
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-4135
Mailing Address - Country:US
Mailing Address - Phone:216-696-2197
Mailing Address - Fax:216-696-2088
Practice Address - Street 1:1515 W 29TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-2906
Practice Address - Country:US
Practice Address - Phone:216-696-2197
Practice Address - Fax:216-696-2088
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH84161101YA0400X
OHS77241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)