Provider Demographics
NPI:1598845414
Name:SERNA, ANTONIO (MA, LSW, LICDC)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:SERNA
Suffix:
Gender:M
Credentials:MA, LSW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SEVERANCE CIR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1533
Mailing Address - Country:US
Mailing Address - Phone:216-524-7377
Mailing Address - Fax:
Practice Address - Street 1:10 SEVERANCE CIR
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1533
Practice Address - Country:US
Practice Address - Phone:216-297-2360
Practice Address - Fax:216-297-2365
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)