Provider Demographics
NPI:1639633878
Name:MCGRAW, LENA CLARICE (CDCA)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:CLARICE
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3364 W 91ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-4834
Mailing Address - Country:US
Mailing Address - Phone:216-630-1608
Mailing Address - Fax:
Practice Address - Street 1:3364 W 91ST ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-4834
Practice Address - Country:US
Practice Address - Phone:216-630-1608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH165991101YA0400X
OH000673175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000673OtherOHIO CERTIFIED PEER RECOVERY SUPPORTER
OH165991OtherOCDP