Provider Demographics
NPI:1659400158
Name:BREMENOUR, MARCIA JOAN (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:JOAN
Last Name:BREMENOUR
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20690 LAKELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-3241
Mailing Address - Country:US
Mailing Address - Phone:216-404-1900
Mailing Address - Fax:216-404-1901
Practice Address - Street 1:20690 LAKELAND BLVD
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-3241
Practice Address - Country:US
Practice Address - Phone:216-404-1900
Practice Address - Fax:216-404-1901
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003026101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional