Provider Demographics
NPI:1740648450
Name:KROST, MARSHA (LSW, LCDC III)
Entity type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:
Last Name:KROST
Suffix:
Gender:F
Credentials:LSW, LCDC III
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:
Other - Last Name:FLEISIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:S1303054
Mailing Address - Street 1:554 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2551
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1320 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-2333
Practice Address - Country:US
Practice Address - Phone:216-781-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDC.151103-3101YA0400X
OHS.1303054104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH340896181Medicaid