Provider Demographics
NPI:1699807941
Name:BEATTIE, LUCI BOOTH (MSW LISW)
Entity Type:Individual
Prefix:MRS
First Name:LUCI
Middle Name:BOOTH
Last Name:BEATTIE
Suffix:
Gender:F
Credentials:MSW LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14322 THATCHERS LANE
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149
Mailing Address - Country:US
Mailing Address - Phone:440-572-9128
Mailing Address - Fax:
Practice Address - Street 1:20325 CENTER RIDGE ROAD
Practice Address - Street 2:SUITE 628
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116
Practice Address - Country:US
Practice Address - Phone:440-331-5570
Practice Address - Fax:440-331-3221
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI5971104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker