Provider Demographics
NPI:1558547554
Name:LEVENDULA, JUDY DIANE (LISW)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:DIANE
Last Name:LEVENDULA
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 1:3656 TRAYNHAM RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5145
Mailing Address - Country:US
Mailing Address - Phone:216-991-3592
Mailing Address - Fax:216-991-3592
Practice Address - Street 1:3656 TRAYNHAM RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5145
Practice Address - Country:US
Practice Address - Phone:216-991-3592
Practice Address - Fax:216-991-3592
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 12291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical