Provider Demographics
NPI:1528192077
Name:MONCRIEF, JESSICA (LISW-S)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:MONCRIEF
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 1:1649 ONONDAGA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4310
Mailing Address - Country:US
Mailing Address - Phone:216-221-4697
Mailing Address - Fax:
Practice Address - Street 1:303 E BAGLEY RD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-2040
Practice Address - Country:US
Practice Address - Phone:440-260-8372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00095101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical