Provider Demographics
NPI:1598253486
Name:LEMOINE PSYCHOTHERAPY INC
Entity Type:Organization
Organization Name:LEMOINE PSYCHOTHERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:LEMOINE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:216-978-8602
Mailing Address - Street 1:5968 ASHCROFT DR
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3137
Mailing Address - Country:US
Mailing Address - Phone:216-978-8602
Mailing Address - Fax:931-901-1239
Practice Address - Street 1:35010 CHARDON RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-9010
Practice Address - Country:US
Practice Address - Phone:216-978-8602
Practice Address - Fax:931-901-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI10002961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI1000296OtherLICENSE