Provider Demographics
NPI:1679031280
Name:JUDGE, LAMONT RASHAWN SR (LSW)
Entity Type:Individual
Prefix:MR
First Name:LAMONT
Middle Name:RASHAWN
Last Name:JUDGE
Suffix:SR
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3865 MONTEVISTA RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1612
Mailing Address - Country:US
Mailing Address - Phone:216-835-0806
Mailing Address - Fax:
Practice Address - Street 1:6200 ROCKSIDE WOODS BLVD N
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2333
Practice Address - Country:US
Practice Address - Phone:216-835-0806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1903305104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker