Provider Demographics
NPI:1730117847
Name:FOSTER, JOAN A (LISW, LICDC)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:A
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LISW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3461 WARRENSVILLE CENTER RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5227
Mailing Address - Country:US
Mailing Address - Phone:216-751-4763
Mailing Address - Fax:216-751-4599
Practice Address - Street 1:3461 WARRENSVILLE CENTER RD
Practice Address - Street 2:SUITE 304
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5227
Practice Address - Country:US
Practice Address - Phone:216-751-4763
Practice Address - Fax:216-751-4599
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH965799101YA0400X
OHI. 00048311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical