Provider Demographics
NPI:1629386313
Name:MORGAN-CRISTIAN, ANN E (LISW-SUPV)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:MORGAN-CRISTIAN
Suffix:
Gender:F
Credentials:LISW-SUPV
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:E
Other - Last Name:CRISTIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW-SUPV
Mailing Address - Street 1:11801 BUCKEYE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-2620
Mailing Address - Country:US
Mailing Address - Phone:216-831-2255
Mailing Address - Fax:216-378-3906
Practice Address - Street 1:3737 LANDER RD
Practice Address - Street 2:
Practice Address - City:PEPPER PIKE
Practice Address - State:OH
Practice Address - Zip Code:44124-5712
Practice Address - Country:US
Practice Address - Phone:216-831-2255
Practice Address - Fax:216-378-3906
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.000534-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268768Medicaid