Provider Demographics
NPI:1518343334
Name:DICKS, LAUREN D'LEE (LISW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:D'LEE
Last Name:DICKS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 MAYFIELD RD
Mailing Address - Street 2:APT 204
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-5217
Mailing Address - Country:US
Mailing Address - Phone:216-780-6186
Mailing Address - Fax:
Practice Address - Street 1:1740 PAYNE AVE
Practice Address - Street 2:SUITE 190
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114
Practice Address - Country:US
Practice Address - Phone:216-987-7041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.14514051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical