Provider Demographics
NPI:1558951186
Name:TEPPER, CYNTHIA JOY (LSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JOY
Last Name:TEPPER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2574 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1773
Mailing Address - Country:US
Mailing Address - Phone:216-244-1322
Mailing Address - Fax:
Practice Address - Street 1:12417 CEDAR RD STE 21
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3157
Practice Address - Country:US
Practice Address - Phone:216-485-3779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1903774104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker