Provider Demographics
NPI:1528179959
Name:FALVO, ELLEN M (LISW-S)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:M
Last Name:FALVO
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33391 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1289
Mailing Address - Country:US
Mailing Address - Phone:216-577-1873
Mailing Address - Fax:440-314-2111
Practice Address - Street 1:3500 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2641
Practice Address - Country:US
Practice Address - Phone:440-314-2111
Practice Address - Fax:440-260-8576
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00294011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0308483Medicaid
OHBOSW30271Medicare ID - Type UnspecifiedMEDICARE NUMBER
OHBOSW30272Medicare ID - Type UnspecifiedMEDICARE NUMBER